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MEDICAL EXAMINATION REPORT
For Commerical Driver Fitness Determination
DRIVER’S INFORMATION
HEALTH HISTORY
Driver completes this section, but medical examiner is encouraged to discuss with driver.
Any illness or injury in last five years? Diabetes or elevated blood sugar controlled by: Head/Brain injuries, disorders or illnesses Eye disorders or impaired vision (except corrective lenses) Nervous or psychiatric disorders, e.g. severe depression Ear disorders, loss of hearing or balance Heart disease or heart attack; other cardiovascular condition Heart surgery (valve replacement/bypass, angioplasty, pace- Sleep disorders, pauses in breathing while asleep, daytime Missing or impaired hand, arm, foot, leg, finger, toe Lung disease, emphysema, asthma, chronic bronchitis For any YES answer, indicate onset date, diagnosis, treating physician’s name and address, and any current limitation. List allmedications (including over-the-counter medications) used regularly or recently.
I certify that the above information is complete and true. I understand that inaccurate, false or missing information may invalidate theexamination and my Medical Examiner’s Certificate.
Medical Examiner’s Comments on Health History (The medical examiner must review and discuss with the driver any "yes" answers
and potential hazards of medications, including over-the-counter medications, while driving.)
TESTING (Medical Examiner completes Section 3 through 7)
Standard: At least 20/40 acuity (Snellen) in each eye with or without correction. At least 70° peripheral
in horizontal meridian measured in each eye. The use of corrective lenses should be noted on the Medical
Examiner’s Certificate.
INSTRUCTIONS: When other than the Snellen chart is used, give test results in Snellen-comparable values. In recording distance
vision, use 20 feet as normal. Report visual acuity as a ratio with 20 as numerator and the smallest type read at 20 feet as denominator.
If the applicant wears corrective lenses, these should be worn while visual acuity is being tested. If the driver habitually wears contact
lenses, or intends to do so while driving, sufficient evidence of good tolerance and adaptation to their use must be obvious. Monocular
drivers are not qualified.
Numerical readings must be provided.
Applicant can recognize and distinguish among trafficcontrol signals and devices showing standard red, UNCORRECTED
CORRECTED
HORIZONTAL FIELD OF VISION
Applicant meets visual acuity requirement only whenwearing: Complete next line only if vision testing is done by an ophthalmologist or optometrist Name of Ophthalmologist or Optometrist (print) Standard: a) Must first perceive forced whispered voice > 5 ft., with or without hearing aid, or b)
average hearing loss in better ear < 40 dB
Check if hearing aid required to meet standard.
INSTRUCTIONS: To convert audiometric test results from ISO to ANSI, -14 dB from ISO for 500 Hz, -10 dB for 1,000 Hz, -8.5 dB
for 2,000 Hz. To average, add the readings for 3 frequencies tested and divide by 3.
a) Record distance from individual at which Numerical readings must be recorded.
forced whispered voice can first be heard.
b) If audiometer is used, record hearing loss BLOOD PRESSURE/PULSE RATE
Numerical readings must be recorded.
Medical Examiner should take at least two readings to confirm BP.
One-time certificate for 3months if 141-159/91-99.
6 months from date of exam if < 140/90.
LABORATORY AND OTHER TEST FINDINGS
Numerical readings must be recorded.
Urinalysis is required. Protein, blood or sugar in the urine may be an indication for further testing to rule out any underlying medical PHYSICAL EXAMINATION
The presence of a certain condition may not necessarily disqualify a driver, particularly if the condition is controlled adequately, is not likely toworsen or is readily amenable to treatment. Even if a condition does not disqualify a driver, the medical examiner may consider deferring the driver temporarily. Also, the driver should be advised to take the necessary steps to correct the condition as soon as possible particularly if the condition, if neglected, could result in more serious illness that might affect driving.
Check YES if there are any abnormalities. Check NO if the body system is normal. Discuss any YES answers in detail in the space below, andindicate whether it would affect the driver’s ability to operate a commercial motor vehicle safely. Enter applicable item number before each comment. If organic disease is present, note that it has been compensated for.
See Instructions to the Medical Examiner for guidance.
BODY SYSTEM
CHECK FOR:
Marked overweight, tremor, signs of alcoholism, problem drinking, or drug abuse.
Pupillary equality, reaction to light, accommodation, ocular motility, ocular muscle imba-lance, extraocular movement, nystagmus, exophthalmos, strabismus uncorrected by cor-rective lenses, retinopathy, cataracts, aphakia, glaucoma, macular degeneration.
Middle ear disease, occlusion of external canal, perforated eardrums.
Irremediable deformities likely to interfere with breathing or swallowing.
Murmurs, extra sounds, enlarged heart, pacemaker.
Abnormal chest wall expansion, abnormal respiratory rate, abnormal breath sounds including wheezes or alveolar rales, impaired respiratory function, dyspnea, cyanosis.
Abnormal findings on physical exam may require further testing such as pulmonary testsand/or x-ray of chest.
Enlarged liver, enlarged spleen, masses, bruits, hernia, significant abdominal wallmuscle weakness.
Abnormal pulse and amplitude, carotid or arterial bruits, varicose veins.
Loss or impairment of leg, foot, toe, arm, hand, finger. Perceptible limp, deformities, atrophy, weakness, paralysis, clubbing, edema, hypotonia. Insufficient grasp and prehen- sion in upper limb to maintain steering wheel grip. Insufficient mobility and strength in lower limb to operate pedals properly.
Previous surgery, deformities, limitation of motion, tenderness.
Impaired equilibrium, coordination or speech pattern; paresthesia, asymmetric deeptendon reflexes, sensory or positional abnormalities, abnormal patellar and Babinski’sreflexes, ataxia.
Note certification status here.
See Instructions to the Medical Examiner for guidance.
Meets standards in 49 CFR 391.41; qualifies for 2 year certificate Skill Performance Evaluation (SPE) Certificate Meets standards, but periodic evaluation required Driving within an exempt intracity zoneQualified by operation of 49 CFR 391.64 Temporarily disqualified due to (condition or medication): Return to medical examiner’s office for follow up on If meets standards, complete a Medical Examiner’s Certificate according to 49 CFR 391.43(h).
(Driver must carry certificate when operating a commercial vehicle.) 49 CFR 391.41 Physical Qualifications for Drivers
THE DRIVER’S ROLE
Responsibilities, work schedules, physical and emotional demands, and lifestyles among commercial drivers vary by the type of driving thatthey do. Some of the main types of drivers include the following: turn around or short relay (drivers return to their home base each evening); long relay (drivers drive 8-10 hours and then have an 8-hour off-duty period), straight through haul (cross country drivers); and team drivers(drivers share the driving by alternating their 4-hour driving periods and 4-hour rest periods).
The following factors may be involved in a driver’s performance of duties: abrupt schedule changes and rotating work schedules, which may result in irregular sleep patterns and a driver beginning a trip in a fatigued condition; long hours; extended time away from family and friends, whichmay result in lack of social support; tight pickup and delivery schedules, with irregularity in work, rest, and eating patterns, adverse road, weather and traffic conditions, which may cause delays and lead to hurriedly loading or unloading cargo in order to compensate for the lost time; and environmental conditions such as excessive vibration, noise, and extremes in temperature. Transporting passengers or hazardous materials may add to the demands on the commercial driver.
There may be duties in addition to the driving task for which a driver is responsible and needs to be fit. Some of these responsibilities are: coupling and uncoupling trailer(s) from the tractor, loading and unloading trailer(s) (sometimes a driver may lift a heavy load or unload as much as 50,000 lbs. of freight after sitting for a long period of time without any stretching period); inspecting the operating condition of tractor and trailer(s) before, during and after delivery of cargo; lifting, installing, and removing heavy tire chains; and, lifting heavy tarpaulins to cover open top trailers. The above tasksdemand agility, the ability to bend and stoop, the ability to maintain a crouching position to inspect the underside of the vehicle, frequent entering and exiting of the cab, and the ability to climb ladders on the tractor and/or trailer(s).
In addition, a driver must have the perceptual skills to monitor a sometimes complex driving situation, the judgement skills to make quick decisions, when necessary, and the manipulative skills to control an oversize steering wheel, shift gears using a manual transmission, and maneuver a vehicle incrowded areas.
S 391.41 PHYSICAL QUALIFICATIONS FOR DRIVERS
(a) A person shall not drive a commercial motor vehicle unless he is physically qualified to do so and, except as provided in §391.67, has on his person the original, or a photographic copy, of a medical examiner’s certificate that he is physically qualified to drive a commercial motor vehicle.
(b) A person is physically qualified to drive a motor vehicle if that person: (1) Has no loss of a foot, a leg, a hand, or an arm, or has been granted a Skill Performance Evaluation (SPE) Certificate (formerly Limb Waiver Program) pursuant to §391.49.
(2) Has no impairment of: (i) A hand or finger which interferes with perhension or power grasping; or (ii) An arm, foot, or leg which interferes with the ability to perform normal tasks associated with operating a commercial motor vehicle; or any other significant limb defect or limitation whichinterferes with the ability to perform normal tasks associated with operating a commercial motor vehicle; or has been granted a SPE Certificate pursuant to §391.49.
(3) Has no established medical history or clinical diagnosis of diabetes mellitus currently requiring insulin for control; (4) Has no currently clinical diagnosis of myocardial infarction, angina pectoris, coronary insufficiency, thrombosis or any other cardiovascular disease of a variety known to be accompanied by syncope, dyspnea, collapse, or congestive cardiac failure.
(5) Has no established medical history or clinical diagnosis of a respiratory dysfunction likely to interfere with his ability to control and drive (6) Has no current clinical diagnosis of high blood pressure likely to interfere with his ability to operate a commercial motor vehicle safely.
(7) Has no established medical history or clinical diagnosis of rheumatic, arthritic, orthopedic, muscular, neuromuscular, or vascular disease which interferes with his ability to control and operate a commercial motor vehicle safely.
(8) Has no established medical history or clinical diagnosis of epilepsy or any other condition which is likely to cause loss of consciousness or any loss of ability to control a commercial motor vehicle; (9) Has no mental, nervous, organic, or functional disease or psychiatric disorder likely to interfere with his ability to drive a commercial (10) Has distant visual acuity of at least 20/40 (Snellen) in each eye without corrective lenses or visual acuity separately corrected to 20/40 (Snellen) or better with corrective lenses, distant binocular acuity of at least 20/40 (Snellen) in both eyes with or without corrective lenses, field ofvision of at least 70 degrees in the horizontal meridian in each eye, and the ability to recognize the colors of traffic signals and devices showingstandard red, green and amber; (11) First perceives a forced whispered voice in the better ear not less than 5 feet with or without the use of a hearing aid, or, if tested by use of an audiometric device, does not have an average hearing loss in the better ear greater than 40 decibels at 500 Hz, 1,000 Hz and 2,000 Hzwith or without a hearing aid when the audiometric device is calibrated to American National Standard (formerly ASA Standard) Z24.5-1951; (12) (i) Does not use a controlled substance identified in 21 CFR 1308.11 Schedule I, an amphetamine, a narcotic, or any other habit-forming drug. (ii) Exception: A driver may use such a substance or drug, if the substance or drug is prescribed by a licensed medical practitioner who: (A) Isfamiliar with the driver’s medical history and assigned duties; and (B) Has advised the driver that the prescribed substance or drug will not adversely affect the driver’s ability to safely operate a commercial motor vehicle; and, (13) Has no current clinical diagnosis of alcoholism.
INSTRUCTIONS TO THE MEDICAL EXAMINER
General Information
The purpose of this examination is to determine a driver’s physical qualification to operate a commercial motor vehicle (CMV) in interstate commerce according to the requirements in 49 CFR 391.41-49. Therefore, the medical examiner must be knowledgeable of these requirements and guidelinesdeveloped by the FMCSA to assist the medical examiner in making the qualification determination. The medical examiner should be familiar with the driver’s responsibilities and work environment and is referred to the section on the form, The Driver’s Role.
In addition to reviewing the Health History section with the driver and conducting the physical examination, the medical examiner should discuss common prescriptions and the over-the-counter medications relative to the side effects and hazards of these medications while driving. Educate driver to read warning labels on all medications. History of certain conditions may be cause for rejection, particularly if required by regulation, or may indicate the need for additional laboratory tests or more stringent examination perhaps by a medical specialist. These decisions are usually made by the medical examiner in light of the driver’s job responsibilities, work schedule and potential for the condition to render the driver unsafe.
Medical conditions should be recorded even if they are not cause for denial, and they should be discussed with the driver to encourage appropriate remedial care. This advice is especially needed when a condition, if neglected, could develop into a serious illness that could affect driving.
If the medical examiner determines that the driver is fit to drive and is also able to perform non-driving responsibilities as may be required, the medical examiner signs the medical certificate which the driver must carry with his/her license. The certificate must be dated. Under current regulations, the certificate is valid for two years, unless the driver has a medical condition that does not prohibit driving but does require more frequent monitoring. In such situations, the medical certificate should be issued for a shorter length of time. The physical examination should be done carefully and at least as complete as indicated by the attached form. Contact the FMCSA at (202) 366-1790 for further information (a vision exemption, qualifying driversunder 49 CFR 391-64, etc.).
Federal Motor Carrier Safety Regulations
- Advisory Criteria -
Interpretation of Medical Statements
Since the issuance of the regulations for physical qualifications of commercial drivers, the Federal Motor Carriers Safety Administration (FMCSA) has published recommendations called Advisory Criteria to help medical examiners in determining whether a driver meets the physical qualifications forcommercial driving. These recommendations have been condensed to provide information to medical examiners that (1) is directly relevant to thephysical examination and (2) is not already included in the medical examiner’s form. The specific regulation is printed in italics and its reference bysection is highlighted.
Loss of Limb:
S 391.41(b)(1)
A person is physically qualified to drive a commercial motor vehicle if that person:Has no loss of a foot, leg, hand or an arm, or has been granted a Skill Performance Evaluation (SPE) Certificate pursuant to Section 391.49. Limb Impairment:
S 391.41(b)(2)
A person is physically qualified to drive a commercial motor vehicle if that person:Has no impairment of: (i) A hand or finger which interferes with prehension or power grasping; or (ii) An arm, foot, or leg which interferes with theability to perform normal tasks associated with operating a commercial motor vehicle; or (iii) Any other significant limb defect or limitation whichinterferes with the ability to perform normal tasks associated with operating a commercial motor vehicle; or, (iv) Has been granted a Skill Performance Evaluation Certificate pursuant to Section 391.49. A person who suffers loss of a foot, leg, hand or arm or whose limb impairment in any way interferes with the safe performance of normal tasks associated with operating a commercial motor vehicle is subject to the Skill Performance Evaluation (SPE) Certification Program pursuant to section391.49, assuming the person is otherwise qualified.
With the advancement of technology, medical aids and equipment modifications have been developed to compensate for certain disabilities. The SPE Certification Program (formerly the Limb Waiver Program) was designed to allow persons with the loss of a foot or limb or with functional impairment to qualify under the Federal Motor Carrier Safety Regulations (FMCSRs) by use of prosthetic devices or equipment modifications which enable them to safely operate a commercial motor vehicle. Since there are no medical aids equivalent to the original body or limb, certain risks are still present,and thus restrictions may be included on individual SPE certificates when a State Director for the FMCSA determines they are necessary to beconsistent with safety and public interest.
If the driver is found otherwise medically qualified (301.41(b)(3) through (13),), the medical examiner must check on the medical certificate that the driver is qualified only if accompanied by a SPE certificate. The driver and the employing motor carrier are subject to appropriate penalty if thedriver operates a motor vehicle in interstate or foreign commerce without a current SPE certificate for his/her physical disability.
INSTRUCTIONS TO THE MEDICAL EXAMINER (CONTINUED)
Federal Motor Carrier Safety Regulations - Advisory Criteria - (Continued)
Diabetes
S 391.41(b)(3)
A person is physically qualified to drive a commercial motor vehicle if that person:
Has no established medical history or clinical diagnosis of diabetes mellitus currently requiring insulin for control.
Diabetes mellitus is a disease which, on occasion, can result in a loss of consciousness or disorientation in time and space. Individuals who require insulin for control have conditions which can get out of control by the use of too much or too little insulin, or food intake not consistent withthe insulin dosage. Incapacitation may occur from symptoms of hyperglycemic or hypoglycemic reactions (drowsiness, semiconsciousness, diabeticcoma or insulin shock).
The administration of insulin is, within itself, a complicated process requiring insulin, syringe, needle, alcohol sponge and a sterile technique.
Factors related to a long-haul commercial motor vehicle operations, such as fatigue, lack of sleep, poor diet, emotional conditions, stress, and concomitant illness, compound the diabetic problem. Thus, because of these inherent dangers, the FMCSA has consistently held that a diabetic who uses insulinfor control does not meet the minimum physical requirements of the FMCSRs.
Hypoglycemic drugs, taken orally, are sometimes prescribed for diabetic individuals to help stimulate natural body production of insulin. If the condition can be controlled by the use of oral medication and diet, then an individual may be qualified under the present rule.
(See Conference Report on Diabetic Disorders and Commercial Drivers and Insulin-Using Commercial Motor Vehicle Drivers at: http://www.fmcsa.dot.gov/rulesregs/medreports.htm) Cardiovascular Condition
S
S 391.41(b)(4)
A person is physically qualified to drive a commercial motor vehicle if that person:Has no current clinical diagnosis of myocardial infarction, angina pectoris, coronary insufficiency, thrombosis or any other cardiovascular disease of a variety known to be accompanied by syncope, dyspnea, collapse or congestive cardiac failure. The term "has no current clinical diagnosis of" is specifically designed to encompass: "a clinical diagnosis of" (1) a current cardiovascular condition, or (2) a cardiovascular condition which has not fully stabilized regardless of the time limit. The term "known to be accompanied by" is defined to include: a clinical diagnosis of a cardiovascular disease (1) which is accompanied by symptoms of syncope, dyspnea, collapse or congestive cardiac failure; and/or (2) which is likely to cause syncope, dyspnea, collapse or congestive cardiac failure.
It is the intent of the FMCSRs to render unqualified, a driver who has a current cardiovascular disease which is accompanied by and/or likely to cause symptoms of syncope, dyspnea, collapse, or congestive cardiac failure. However, the subjective decision of whether the nature and severity of an individual’s condition will likely cause symptoms of cardiovascular insufficiency is on an individual basis and qualification rests with the medicalexaminer and the motor carrier. In those cases where there is an occurrence of cardiovascular insufficiency (myocardial infarction, thrombosis, etc.),it is suggested before a driver is certified that he or she have a normal resting and stress electrocardiogram (ECG) no residual complications and no physical limitations, and taking no medication likely to interfere with safe driving.
Coronary artery bypass surgery and pacemaker implantation are remedial procedures and thus, not unqualifying. Coumadin is a medical treatment which can improve the health and safety of the driver and should not, by its use, medically disqualify the commercial driver. The emphasis should be on the underlying medical condition(s) which require treatment and the general health of the driver. The FMCSA should be contacted at (202) 366-1790 for additional recommendations regarding the physical qualification of drivers on coumadin.
(See Conference on Cardiac Disorders and Commercial Drivers at: http://www.fmcsa.dot.gov/rulesregs/medreports.htm) Respiratory Dysfunction
S 391.41(b)(5)
A person is physically qualified to drive a commercial motor vehicle if that person:Has no established medical history or clinical diagnosis of a respiratory dysfunction likely to interfere with ability to control and drive a commercialmotor vehicle safely. Since a driver must be alert at all times, any change in his or her mental state is in direct conflict with highway safety. Even the slightest impairment in respiratory function under emergency conditions (when greater oxygen supply is necessary for performance) may be detrimental to safe driving.
There are many conditions that interfere with oxygen exchange and may result in incapacitation, including emphysema, chronic asthma, carcinoma, tuberculosis, chronic bronchitis and sleep apnea. If the medical examiner detects a respiratory dysfunction, that in any away is likely to interfere with the driver’s ability to safely control and drive a commercial motor vehicle, the driver must be referred to a specialist for further evaluation and therapy. Anticoagulation therapy for deep vein thrombosis and/or pulmonary thromboembolism is not unqualifying once optimum dose is achieved, providedlower extremity venous examinations remain normal and the treating physician gives a favorable recommendation.
(See Conference on Pulmonary/Respiratory Disorders and Commercial Drivers at: http://www.fmcsa.dot.gov/rulesregs/medreports.htm) INSTRUCTIONS TO THE MEDICAL EXAMINER (CONTINUED)
Federal Motor Carrier Safety Regulations - Advisory Criteria - (Continued)
Hypertension
S 391.41(b)(6)
A person is physically qualified to drive a commercial motor vehicle if that person:
Has no current clinical diagnosis of high blood pressure likely to interfere with ability to operate a commercial motor vehicle safely.
Hypertension alone is unlikely to cause sudden collapse; however, the likelihood increases when target organ damage, particularly cerebral vascular disease is present. This regulatory criteria is based upon FMCSA’s Cardiovascular Advisory Guidelines for the Examination of CMV Drivers, which used the Sixth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (1997).
Stage 1 hypertension corresponds to a systolic BP of 140-159 mmHg and/or a diastolic BP of 90-99 mmHg. The driver with a BP in this range is at low risk for hypertension-related acute incapacitation and may be medically certified to drive for a one-year period. Certification examinationsshould be done annually thereafter and should be at or less than 140/90. If less than 160/100, certification may be extended one time for 3 months.
A blood pressure of of 160-179 systolic and/or 100-109 diastolic is considered Stage 2 hypertension, and the driver is not necessarily unqualified during evaluation and institution of treatment. The Driver is given a one-time certification of three months to reduce his or her blood pressure to lessthan or equal to 140/90. A blood pressure in this range is an absolute indication for anti-hypertensive drug therapy. Provided treatment is well tolerated and the driver demonstrates a BP value of 140/90 or less, he or she may be certified for one year from date of the initial exam. The driver is certified annually thereafter.
A blood pressure at or greater than 180 systolic and 110 diastolic is considered Stage 3 hypertension, which indicates a high risk for an acute BP-related event. The driver may not be qualified, even temporarily, until reduced to 140/90 or less and treatment is well tolerated. The driver may be certified for 6 months and biannually (every 6 months) thereafter if at recheck the BP is 140/90 or less.
Annual recertification is recommended if the medical examiner does not know the severity of hypertension prior to treatment.
An elevated blood pressure finding should be confirmed by at least two subsequent measurements on different days.
Treatment includes nonpharmacologic and pharmacologic modalities as well as counseling to reduce other risk factors. Most antihypertensive medications also have side effects, the importance of which must be judged on an individual basis. Individuals must be alerted to the hazards of these medications while driving. Side effects of somnolence or syncope are particularly undesirable in commercial drivers.
Secondary hypertension is based on the above stages. Evaluation is warranted if patient is persistently hypertensive on maximal or near-maximal doses of 2-3 pharmacologic agents. Some causes of secondary hypertension may be amenable to surgical intervention or specific pharmacologicdisease (See Cardiovascular Advisory Panel Guidelines for the Medical Examination of Commercial Motor Vehicle Drivers at:http://www.fmcsa.dot.gov/rulesregs/medreports.htm).
Rheumatic, Arthritic, Orthopedic, Muscular, Neuromuscular or Vascular Disease
S
S 391.41(b)(7)
A person is physically qualified to drive a commercial motor vehicle if that person:
Has no established medical history or clinical diagnosis of rheumatic, arthritic, orthopedic, muscular, neuromuscular or vascular disease which interferes
with ability to control and operate a commercial motor vehicle safely.
Certain diseases are known to have acute episodes of transient muscle weakness, poor muscular coordination (ataxia), abnormal sensations (paresthesia), decreased muscular tone (hypotonia), visual disturbances and pain which may be suddenly incapacitating. With each recurring episode, these symptoms may become more pronounced and remain for longer periods of time. Other diseases have more insidious onsets and display symptoms of muscle wasting (atrophy), swelling and paresthesia which may not suddenly incapacitate a person but may restrict his/her movements and eventually interfere with the ability to safely operate a motor vehicle. In many instances these diseases are degenerative in nature or may result in deterioration of the involved area.
Once the individual has been diagnosed as having a rheumatic, arthritic, orthopedic, muscular, neuromuscular or vascular disease, then he/she has an established history of that disease. The physician, when examining an individual, should consider the following: (1) the nature and severity of the individual’s condition (such as sensory loss or loss of strength); (2) the degree of limitation present (such as range of motion); (3) the likelihoodof progressive limitation (not always present initially but may manifest itself over time); and (4) the likelihood of sudden incapacitation. If severe functional impairment exists, the driver does not qualify. In cases where more frequent monitoring is required, a certificate for a shorter time period may be issued (See Conference on Neurological Disorders and Commercial Drivers at: http://www.fmcsa.dot.gov/rulesregs/medreports.htm).
INSTRUCTIONS TO THE MEDICAL EXAMINER (CONTINUED)
Federal Motor Carrier Safety Regulations - Advisory Criteria - (Continued)
Epilepsy
S
S 391.41(b)(8)
A person is physically qualified to drive a commercial motor vehicle if that person:
Has no established medical history or clinical diagnosis of epilepsy or any other condition which is likely to cause loss of consciousness or any loss
of ability to control a motor vehicle.
Epilepsy is a chronic functional disease characterized by seizures or episodes that occur without warning, resulting in loss of consciousness and/or seizures. Therefore, the following drivers cannot be qualified: (1) a driver who has a medical history of epilepsy; (2) a driver who has acurrent clinical diagnosis of epilepsy; or (3) a driver who is taking antiseizure medication.
If an individual has had a sudden episode of a nonepileptic seizure or loss of consciousness of unknown cause which did not require antiseizure medication, the decision as to whether that person’s condition will likely cause loss of consciousness or loss of ability to control a motor vehicle ismade on an individual basis by the medical examiner in consultation with the treating physician. Before certification is considered, it is suggested that a 6-month waiting period elapse from the time of the episode. Following the waiting period, it is suggested that the individual have a complete neurological examination. If the results of the examination are negative and antiseizure or episode loss of consciousness that resulted from a known medicalcondition (e.g., drug reaction, high temperature, acute infectious disease, dehydration or acute metabolic disturbance), certification should be deferred until the driver has fully recovered from that condition and has no existing residual complications, and not taking antiseizure medication.
(See Conference on Neurological Disorders and Commercial Drivers at: http://www.fmcsa.dot.gov/rulesregs/medreports.htm) Mental Disorders
S
S 391.41(b)(9)
A person is physically qualified to drive a commercial motor vehicle if that person: Has no mental, nervous, organic or functional disease or psychiatric disorder likely to interfere with ability to drive a motor vehicle safely. Emotional or adjustment problems contribute directly to an individual’s level of memory, reasoning, attention and judgement. These problems often underlie physical disorders. A variety of functional disorders can cause drowsiness, dizziness, confusion, weakness or paralysis that may leadto incoordination, inattention, loss of functional control and susceptibility to accidents while driving. physical fatigue, headache, impaired coordination, recurring physical ailments and chronic "nagging" pain may be present to such a degree that certification of commercial driving is inadvisable. Somatic and physchosomatic complaints should be thoroughly examined when determining an individual’s overall fitness to drive. Disorders of a periodicallyincapacitating nature, even in the early stages of development, may warrant disqualification.
Many bus and truck drivers have documented that "nervous trouble" related to neurotic, personality, emotional or adjustment problems is responsible for significant fraction of their preventable accidents. The degree to which an individual is able to appreciate, evaluate and adequately respond toenvironmental strain and emotional stress is critical when assessing an individual’s mental alertness and flexibility to cope with the stresses of commercial motor vehicle driving.
When examining the driver, it should be kept in mind that individuals who live under chronic emotional upsets may have deeply ingrained maladaptive or erratic behavior patterns. Excessively antagonistic, instinctive, impulsive, openly aggressive, paranoid or severely depressed behavior greatly interfere with the driver’s ability to drive safely. Those individuals who are highly susceptible to frequent states of emotional instability(schizophrenia, affective psychoses, paranoia, anxiety or depressive neuroses) may warrant disqualification. See Psychiatric Conference Report forspecific recommendations on the use of these medications and potential hazards for driving.
(See Conference on Psychiatric Disorders and Commercial Drivers at: http://www.fmcsa.dot.gov/rulesregs/medreports.htm) S 391.41(b)(10)
A person is physically qualified to drive a commercial motor vehicle if that person: Has distant visual acuity of at least 20/40 (Snellen) in each eye with or without corrective lenses or visual acuity separately corrected to 20/40 (Snellen) or better with corrective lenses, distant binocular acuity of at least 20/40 (Snellen) in both eyes with or without corrective lenses, field of vision of atleast 70 degrees in the horizontal meridian in each eye, and the ability to recognize the colors of traffic signals and devices showing standard red,green, and amber. The term "ability to recognize the colors of" is interpreted to mean if a person can recognize and distinguish among traffic control signals and devices showing standard red, green and amber, he or she meets the minimum standard, even though he or she may have some type of color perception deficiency. If certain color perception tests are administered, (such as Ishihara, Pseudoisochromatic, Yarn) and doubtful findings are discovered, acontrolled test using signal red, green and amber may be employed to determine the driver’s ability to recognize these colors.
Contact lenses are permissible if there is sufficient evidence to indicate that the driver has good tolerance and is well adapted to their use. Use of a contact lens in one eye for distance visual acuity and another lens in the other eye for near vision is not acceptable, or telescopic lenses acceptable for the driving of commercial motor vehicles.
If an individual meets the criteria by the use of glasses or contact lenses, the following statement shall appear on the Medical Examiner’s Certificate: "Qualified only if wearing corrective lenses." (See Visual Disorders and Commerical Drivers at: http://www.fmcsa.dot.gov/rulesregs/medreports.htm) INSTRUCTIONS TO THE MEDICAL EXAMINER (CONTINUED)
Federal Motor Carrier Safety Regulations - Advisory Criteria - (Continued)
S 391.41(b)(11)
A person is physically qualified to drive a commercial motor vehicle if that person:
First perceives a forced whispered voice in the better ear at not less than 5 feet with or without the use of a hearing aid, or, if tested by use of anaudiometric device, does not have an average hearing loss in the better ear greater than 40 decibels at 500 Hz, 1,000 Hz, and 2,000 Hz with or without a hearing aid when the audiometric device is calibrated to American National Standard (formerly ASA Standard) Z24.5-1951. Since the prescribed standard under the FMCSRs in the American Standards (ANSI), it may be necessary to convert the audiometric results from the ISO standard to the ANSI standard. Instructions are included on the Medical Examination report form.
If an individual meets the criteria by using a hearing aid, the driver must wear that hearing aid and have it in operation at all times while driving. Also, the driver must be in possession of a spare power source for the hearing aid.
For the whispered voice test, the individual should be stationed at least 5 feet from the examiner with the ear being tested turned toward the examiner. The other ear is covered. Using the breath which remains after a normal expiration, the examiner whispers words or random numbers such as 66, 18, 23, etc. The examiner should not use only sibilants (s-sounding test materials). The opposite ear should be tested in the same manner. Ifthe individual fails the whispered voice test, the audiometric test should be administered.
If the individual meets the criteria by the use of a hearing aid, the following statement must appear on the Medical Examiner’s Certificate "Qualified only when wearing a hearing aid."(See Hearing Disorders and Commerical Motor Vehicle Drivers at: http://www.fmcsa.dot.gov/rulesregs/medreports.htm) S 391.41(b)(12)
A person is physically qualified to drive a commercial motor vehicle if that person:
Does not use a controlled substance identified in 21 CFR 1308.II. Schedule I, an amphetamine, a narcotic, or any other habit-forming drug. Exception: A driver may use such a substance or drug, if the substance or drug is prescribed by a licensed medical practitioner who is familiar with the driver’smedical history and assigned duties; and has advised the driver that the prescribed substance or drug will not adversely affect the driver’s ability tosafely operate a commercial motor vehicle. This exception does not apply to methadone. The intent of the medical certification process it to medically evaluate a driver to ensure that the driver has no medical condition which interferes with the safe performance of driver tasks on a public road. If a driver uses a Schedule I drug or other substance, an amphetamine, a narcotic, or any other habit-forming drug, it may be cause for the driver to be found medically unqualified. Motor carriers are encouraged to obtain a practitioner’s written statement about the effects on transportation safety of the use of a particular drug.
A test for controlled substances is not required as part of this biennial certification process. The FMCSA or the driver’s employer should be contacted directly for information on controlled substances and alcohol testing under Part 382 of the FMCSRs.
The term "uses" is designed to encompass instances of prohibited drug use determined by a physician through established medical means. This may or may not involve body fluid testing. If body fluid testing takes place, positive test results should be confirmed by a second test of greaterspecificity. The term "habit-forming" is intended to include any drug or medication generally recognized as capable of being habitual, and which mayimpair the user’s ability to operate a Commerical motor vehicle safely.
The driver is medically unqualified for the duration of the prohibited drug(s) use and until a second examination shows the driver is free from the prohibited drug(s) use. Recertification may involve a substance abuse evaluation, and the negative drug test result. Additionally, given that the certification period is normally two years, the examiner has the option to certify for a period of less than 2 years if this examiner determines more frequent monitoring is required.
(See Conference on Neurological Disorders and Commercial Drivers and Conference on Psychiatric Disorders and Commerical Drivers at:http://www.fmcsa.dot.gov/rulesregs/medreports.htm) Alcoholism
S 391.41(b)(13)
A person is physically qualified to drive a commercial motor vehicle if that person:Has no current clinical diagnosis of alcoholism. The term "current clinical diagnosis of" is specifically designed to encompass a current alcoholic illness or those instances where the individual’s physical condition has not fully stabilized, regardless of the time element. If an individual shows signs of having an alcohol-use problem, he or sheshould be referred to a specialist. After counseling and/or treatment, he or she may be considered for certification.

Source: http://familymedicalcenter.us/yahoo_site_admin/assets/docs/CDL_Physical.10121656.pdf