FMCSA Medical Examiner Handbook

Federal Motor Carrier Safety Administration(FMCSA)Medical Examiner HandbookAs of 2015 this Handbook is no longer in use

Table of ContentsIntroduction . 7Part I – The Federal Motor Carrier Safety Administration (FMCSA) . 8About the FMCSA . 8FMCSA Mission Statement . 8About the Office of Medical Programs . 8The Office of Medical Programs Mission Statement . 8About the National Registry of Certified Medical Examiners . 9The National Registry of Certified Medical Examiners Mission Statement . 9The Medical Examiner . 9Medical Certification. 10Privacy and the Medical Examination . 10Medical Examination Report Form. 10Medical Examiner’s Certificate. 11Medical Regulations Summary . 11Code of Federal Regulations — LAW . 11Medical Standards/Advisory Criteria/Guidelines . 12Medical Regulations Summary Table . 12Exemptions . 14Important Definitions . 14Regulation Definitions . 14Part II - The Job of Commercial Driving . 16FMCSA Regulates Interstate Commercial Operation . 16Drivers. 16Vehicles. 16Truck and Bus Companies. 16State Regulations. 17The Driver and the Job of Commercial Driving . 17The Driver . 17The Job of Commercial Driving. 18FMCSA Commercial Driving Facts and Research . 20Office of Analysis, Research, and Technology . 20Part III - Medical Examination Guidelines . 23About 49 CFR 391.43 . 23Purpose of Interstate Commercial Driver Physical Examination. 23Driver/Medical Examiner Relationship . 23Purpose of Physical Examination. 23The Issue Is Risk. 23Consider Safety Implications. 24Page 2 of 260

Medical Examiner Do's . 24Medical Examination Report Form - Overview . 25Driver Information. 26Health History. 27Vision . 33Hearing. 34Blood Pressure/Pulse. 36Urinalysis. 38Physical Examination . 39Determine Certification Status . 43Certify. 44Disqualify. 48Issue Medical Examiner's Certificate . 49Part IV - Physical Qualification Standards and Advisory Criteria . 51Physical Qualification Standards (Regulations) versus Advisory Criteria (Medical Guidelines) . 51Ongoing Standards and Guidelines Review Process . 51About 49 CFR 391.41 . 52Vision . 52Vision Regulation 49 CFR 391.41(b)(10) . 52Health History and Physical Examination . 53Certification and Documentation . 56Hearing. 59Hearing Regulation 49 CFR 391.41(b)(11) . 60Health History and Physical Examination . 60Certification and Documentation . 62Advisory Criteria/Guidance . 63Hypertension . 64Blood Pressure (BP) Regulations 49 CFR 391.41(b)(6) and 49 CFR 391.43(f) . 65Health History and Physical Examination . 65Advisory Criteria/Guidance . 67Cardiovascular . 73Cardiovascular Regulation 49 CFR 391.41(b)(4). 73Health History and Physical Examination . 74Advisory Criteria/Guidance . 75Respiratory (b)(5) . 117Respiratory Regulation 49 CFR 391.41(b)(5) . 118Health History and Physical Examination . 118Advisory Criteria/Guidance . 120Neurological (b)(7)(8)(9). 136Page 3 of 260

Neurological Regulations 49 CFR 391.41(b)(7)(8)(9) . 137Health History and Physical Examination . 138Advisory Criteria/Guidance . 140Musculoskeletal (b)(1)(2)(7) . 167Musculoskeletal Regulations 49 CFR 391.41(b)(1)(2)(7). 167Health History and Physical Examination . 168Advisory Criteria/Guidance . 170Diabetes Mellitus. 172Diabetes Mellitus Regulation 49 CFR 391.41(b)(3) . 173Health History and Physical Examination . 173Advisory Criteria/Guidance . 175Other Diseases . 181Other Diseases Regulation 49 CFR 391.41(b)(9) . 182Health History and Physical Examination . 182Advisory Criteria/Guidance . 183Psychological Disorders (b)(9) . 185Psychological Regulation 49 CFR 391.41(b)(9). 186Health History and Physical Examination . 186Advisory Criteria/Guidance . 189Drug Abuse and Alcoholism. 201Drug Abuse and Alcoholism Regulations 49 CFR 391.41(b)(12)(13) . 202Health History and Physical Examination . 202About 49 CFR 382 Alcohol and Drug Rules. 204Advisory Criteria/Guidance . 205Medications/Drug Use 49 CFR 391.41(b)(12) . 208Medications/Drug Use Regulation 49 CFR 391.41(b)(12) . 208Health History and Physical Examination . 209Advisory Criteria/Guidance . 211Appendix A: Medical Examination Report Form . 213Medical Examination Report Form - Page 1 . 213Driver Information. 213Health History. 213Medical Examination Report Form - Page 2 . 213Vision . 213Hearing. 214Blood Pressure/Pulse. 214Urinalysis. 214Medical Examination Report Form - Page 3 . 215Physical Examination . 215Page 4 of 260

Certification and Documentation . 215Appendix B: Federal Exemption Programs . 21749 CFR 381.300 What is an exemption? . 217Federal Vision Exemption Program . 217Qualified by Operation of 49 CFR 391.64: "Grandfathered" . 217Federal Diabetes Exemption Program . 218About the Federal Diabetes Exemption Program. 218Relevance to Driving . 219Health History and Physical Examination . 219Appendix C: Skill Performance Evaluation . 223Fixed Deficit of an Extremity . 223Appendix D: Cardiovascular Recommendation Tables . 225Preface. 225ANEURYSMS . 226AORTIC CONGENITAL HEART DISEASE . 227AORTIC CONGENITAL HEART DISEASE (Continued). 228AORTIC REGURGITATION. 229AORTIC STENOSIS . 230ATRIAL SEPTAL DEFECTS . 231ATRIAL SEPTAL DEFECTS (Continued) . 232ATRIAL SEPTAL DEFECTS (Continued) . 233BUNDLE BRANCH BLOCKS AND HEMIBLOCKS. 234CARDIOMYOPATHIES AND CONGESTIVE HEART FAILURE (CHF) . 235COMMERCIAL DRIVERS WITH KNOWN CORONARY HEART DISEASE (CHD) . 236COMMERCIAL DRIVERS WITH KNOWN CORONARY HEART DISEASE (CHD) (Continued) . 237COMMERCIAL DRIVERS WITHOUT KNOWN CORONARY HEART DISEASE (CHD) . 238CONGENITAL HEART DISEASE . 239CONGENITAL HEART DISEASE (Continued) . 240CONGENITAL HEART DISEASE (Continued) .

Demonstrate an understanding of FMCSA physical qualification requirements and the demands of commercial driving, driver tasks, and the work environment. Perform driver certification examinations in accordance with FMCSA physical qualification requirements and medical guidelines.