Federal Motor Carrier Safety Administration (FMCSA)

1 DRAFT. Federal Motor Carrier Safety Administration (FMCSA). NATIONAL REGISTRY OF CERTIFIED. medical EXAMINERS: medical Examiner Handbook 2021 Edition 1. DRAFT. Table of Contents FMCSA will update the Table of Contents once all comments have been addressed Introduction .. 5. Part I The Federal Motor Carrier Safety Administration (FMCSA) .. 5. About the FMCSA .. 5. The medical 5. medical Certification .. 6. Driver examination Forms ..6. medical examination report Form, MCSA-5875 .. 6. medical Examiner's Certificate, Form MCSA-5876 .. 7. CMV Driver medical examination Results Form, MCSA-5850 (electronic only).

2 7. Insulin-Treated Diabetes Mellitus Assessment Form, MCSA-5870 .7. Driver Medication Form, MCSA-5895 ..7. Regulations Summary Code of Federal Regulations ..8. Regulations Summary Table ..9. medical Exemptions .. 10. Regulation Definitions .. 10. Part II - The Job of Commercial Driving .. 11. FMCSA Regulates Interstate Commercial Operation .. 11. drivers .. 12. Vehicles .. 12. Truck and Bus Companies .. 12. State Regulations .. 12. Driver medical Certification 12. medical Examiner Responsibilities ..13. Part III Physical Qualification Standards and Guidance.

3 13. About 49 CFR ..13. Driver/ medical Examiner Relationship ..13. Purpose of Physical Qualification The Issue of Risk ..13. medical Examiner Do's ..14. Part IV Physical Qualification Standards and Advisory Criteria ..14. Physical Qualification Standards (Regulations) versus Guidance (Advisory Criteria, medical Guidelines) .. 14. About 49 CFR ..15. Vision ..15. Vision Regulation 49 CFR (b)(10) ..15. medical Advisory Criteria ..15. Health History and Physical examination ..15. Visual Acuity Test Results, Peripheral 2. DRAFT. Federal Vision Exemption ..17. Hearing.

4 17. Hearing Regulation 49 CFR (b)(11) ..17. medical Advisory Criteria ..17. Hearing Physical examination 18. Federal Hearing Exemption 18. Hypertension ..19. Blood Pressure (BP) Regulations 49 CFR (b)(6) and 49 CFR (f)..19. medical Advisor Criteria ..19. Recommendation Table on Hypertension ..20. Health History and Physical examination ..21. Laboratory and Other Test Findings ..21. Physical examination medical Examiner Responsibility ..21. Cardiovascular Regulation 49 CFR (b)(4) ..22. medical Advisory Criteria ..22. Anticoagulant Therapy ..23. Abdominal Aortic Aneurysm.

5 23. Acute Deep Vein Thrombosis . 23. Thoracic Aneurysm ..24. Pulmonary Emboli ..24. Superficial phlebitis/Varicose Veins ..24. Cardiac Arrhythmias/Defibrillators/Pacemakers ..24. Arial Fibrillation/Ventricular Arrhythmias .. 25. Cardiovascular Testing for Further Assessments ..26. Myocardial Infarction ..27. Angina Pectoris ..27. Coronary Artery Bypass Grafting . 28. Heart Failure ..28. Percutaneous Coronary Intervention ..28. Cardiovascular Expert Panel Recommendations Table .29. Congenital Heart Disease ..30. Heart Transplantation ..31. Cardiomyopathy.

6 31. Syncope ..32. Murmurs 32. Aortic Regurgitation/Stenosis .. 33. Mitral Valve Regurgitation/Stenosis/Prolapse ..33. Respiratory.. 34. Respiratory Regulation 49 CFR (b)(5) .. 34. 3. DRAFT. medical Advisory Criteria .. 34. Allergies and Antihistamines .35..36. Sleep Apnea ..37. Obstructive Sleep Apnea (OSA) 37. Narcolepsy and Hypersomnia 40. Infectious Respiratory Diseases ..41. Tuberculosis ..41. Chest Wall deformities/Cystic Fibrosis/Interstitial lung disease ..41. Pneumothorax/Cor Pulmonale ..42. Rheumatic, Arthritic, Orthopedic, Muscular, Neuromuscular, and Vascular 49 CFR (b)(7).

7 43. medical Advisory Criteria ..43. Seizures Epilepsy 49 CFR (b)(8), Advisory Criteria ..46. Headaches/Dizziness/Vertigo/Meniere's..4 7. Neuromuscular Diseases ..50. Progressive Neurological Disorders-Table .. 51. Cerebrovascular Diseases ..52. Embolic Strokes, Thrombotic Strokes, TIAs ..52. Intracerebral and Subarachnoid Hemorrhages 53. Multiple Sclerosis 53. Traumatic Brain Injury 54. Neurological Events Table ..54. Diabetes Mellitus 49 CFR (b)(3), Advisory Criteria .. 55. Diabetes Mellitus Regulation 49 CFR .. 55. Insulin-Treated Diabetes Mellitus Assessment Form.

8 57. Diabetic Retinopathy ..60. Renal Dialysis ..60. Psychological Disorders and Therapies .. 61. Psychological Regulation 49 CFR (b)(9) .. 61. medical Advisory Criteria .. 61. Psychological Disorders Therapies . 62. Psychological Disorders ..65. Drug Abuse and Alcoholism .. 69. Drug Abuse and Alcoholism Regulations 49 CFR (b)(12) and (13) .. 69. medical Advisory Criteria ..69. About 49 CFR 382 Alcohol and Drug Rules .. 71. Alcoholism ..72. Drug Abuse ..73. Medications/Drug Use .. 73. Medications/Drug Use Regulation 49 CFR (b)(12) .. 74. Schedules of Controlled Substances 21 812.

9 74. 4. DRAFT. medical examination report Form, MCSA-5875 ..75. Completing the medical examination report Form, MCSA-5875 ..75. Determine Certification Status ..78. Determine Certification Interval Overview 79. Certify with Periodic Monitoring ..79. Certify- Require Driver to Have a Federal medical Exemption 79. Certify-SPE Certificate ..80. Certify-Grandfathered 80. Certify-Driving Within an Exempt Intracity Zone 80. Do Not Certify-Discuss and Document Decision ..81. Federal Exemption Programs .. 82. 49 CFR Exemptions .. 82. Federal Vision Exemption Program.

10 82. Federal Hearing Exemption Program .. 82. Federal Seizure Exemption Program .. 83. Skill Performance Evaluation .. 84. Qualified by Operation of 49 CFR : "Grandfathered" .. 84. 5. DRAFT. INTRODUCTION. This handbook provides information about regulatory requirements and guidance to medical Examiners (MEs) listed on FMCSA's National Registry of Certified medical Examiners (National Registry) who perform physical qualification examinations of interstate commercial Motor vehicle (CMV) drivers . Other healthcare professionals, such as medical providers, treating clinicians, and specialists, may provide additional medical information or consultation, but it is the ME who ultimately decides if the driver meets FMCSA's physical qualification standards.