§ 391.43 Medical examination; certificate of physical examination.

(a) Except as provided by paragraph (b) of this section, the medical examination shall be performed by a licensed medical examiner as defined in § 390.5 of this subchapter.
(b) A licensed optometrist may perform so much of the medical examination as pertains to visual acuity, field of vision, and the ability to recognize colors as specified in paragraph (10) of § 391.41(b).
(c) Medical examiners shall:
(1) Be knowledgeable of the specific physical and mental demands associated with operating a commercial motor vehicle and the requirements of this subpart, including the medical regulatoryadvisory criteria prepared by the FHWAFMCSA as guidelines to aid the medical examiner in making the qualification determination; and
(2) Be proficient in the use of and use the medical protocols necessary to adequately perform the medical examination required by this section.
(d) Any driver authorized to operate a commercial motor vehicle within an exempt intracity zone pursuant to § 391.2(d)62 of this part shall furnish the examining medical examiner with a copy of the medical findings that led to the issuance of the first certificate of medical examination which allowed the driver to operate a commercial motor vehicle wholly within an exempt intracity zone.
(e) Any driver operating under a limited exemption authorized by § 391.64 shall furnish the medical examiner with a copy of the annual medical findings of the endocrinologist, ophthalmologist or optometrist, as required under that section. If the medical examiner finds the driver qualified under the limited exemption in § 391.64, such fact shall be noted on the Medical Examiner's Certificate.
(f) The medical examination shall be performed, and its results shall be recorded, substantially in accordance with the following instructions and examination form. Existing forms may be used until current printed supplies are depleted or until MarchNovember 316, 19972001, whichever occurs first.
Instructions for Performing and Recording Physical Examinations
The examining medical examiner must be familiar with 49 CFR 391.41, Physical qualifications for drivers, and should review these instructions before performing the physical examination. Answer each question “yes” or “no” and record numerical readings where appropriateindicated on the physical examination form.
The examining medical examiner shouldmust be aware of the rigorous physical, demands and mental, and emotional responsibilitiesdemands placed on the driver of a commercial motor vehicle. In the interest of public safety, the examining medical examiner is required to certify that the driver does not have any physical, mental, or organic defectcondition ofthat suchmight a nature as to affect the driver's ability to operate safely a commercial motor vehicle safely.
General information. The purpose of this history and physical examination is to detect the presence of physical, mental, or organic defectsconditions of such a character and extent as to affect the applicantdriver's ability to operate a commercial motor vehicle safely. The examination should be madeconducted carefully and should at least asinclude completeall asof indicatedthe byinformation requested in the attachedfollowing form. History of certain defectsconditions may be cause for rejection. orIndicate indicate the need for makingfurther certaintesting laboratory tests and/or arequire further,evaluation andby morea stringent, examinationspecialist. DefectsConditions may be recorded which do not, because of their character or degree, indicate that certification of physical fitness should be denied. However, these defectsconditions should be discussed with the applicantdriver and he/she should be advised to take the necessary steps to insure correction, particularly of those conditions which, if neglected, might lead to a condition likely to affect his/herthe driver's ability to drive safely.
General appearance and development. Note marked overweight. Note any posturepostural defect, perceptible limp, tremor, or other defectsconditions that might be caused by alcoholism, thyroid intoxication, or other illnesses. The Federal Motor Carrier Safety Regulations provide that no driver shall use a narcotic or other habit-forming drugs.
Head-eyes. When other than the Snellen chart is used, the results of such test must be expressed in values comparable to the standard Snellen test. If the applicantdriver wears corrective lenses for driving, these should be worn while applicantdriver's visual acuity is being tested. If appropriatecontact lenses are worn, indicatethere should be sufficient evidence of good tolerance of and adaptation to their use. Indicate the driver's need to wear corrective lenses to meet the vision standard on the Medical Examiner's Certificate by checking the box, “Qualified only when wearing corrective lenses.” In recording distance vision use 20 feet as normal. Report all vision as a fraction with 20 as the numerator and the smallest type read at 20 feet as the denominator. NoteMonocular ptosis,drivers discharge,are visualnot fields,qualified ocularto muscleoperate imbalance,commercial colormotor blindness,vehicles cornealin scar,interstate exophtalmos,commerce.
Ears. orNote strabismusevidence of any ear disease, uncorrectedsymptoms byof correctiveaural lensesvertigo, or Meniere's Syndrome. MonocularWhen driversrecording arehearing, notrecord qualifieddistance tofrom operatepatient commercialat motorwhich vehiclesa underforced existingwhispered Federalvoice Motorcan Carrierfirst Safetybe Regulationsheard. IfFor the driverwhispered habituallyvoice wears contact lensestest, orthe intendsindividual toshould dobe sostationed whileat driving,least there5 shouldfeet befrom sufficientthe evidenceexaminer towith indicatethe thatear he/shebeing hastested goodturned tolerancetoward isthe wellexaminer. adaptedThe toother theirear useis covered. TheUsing usethe ofbreath contactwhich lensesremains shouldafter bea notednormal onexpiration, the record.
Ears.examiner Notewhispers evidencewords ofor mastoidrandom ornumbers middlesuch earas disease66, discharge18, symptoms23, ofetc. auralThe vertigo,examiner orshould Meniere'not use only sibilants (s-sounding Syndrometest materials). WhenThe recordingopposite hearing,ear recordshould distancebe fromtested patientin atthe whichsame amanner. forcedIf the individual fails the whispered voice cantest, firstthe beaudiometric heard.test Ifshould audiometerbe isadministered. usedFor tothe testaudiometric hearingtest, record decibel loss at 500 Hz, 1,000 Hz, and 2,000 Hz.
Throat. NoteAverage evidencethe ofdecibel diseaseloss at 500 Hz, irremediable1,000 deformitiesHz ofand 2,000 Hz and record as described on the throatform. likelyIf tothe interfereindividual withfails eatingthe oraudiometric breathingtest and the whispered voice test has not been administered, orthe anywhispered laryngealvoice conditiontest whichshould couldbe interfereperformed withto determine if the safestandard operationapplicable ofto athat commercialtest motorcan vehiclebe met.
Thorax-heart Throat. StethoscopicNote examinationany isirremediable requireddeformities likely to interfere with breathing or swallowing.
Heart. Note murmurs and arrhythmias, and any past or present history of cardiovascularan diseaseenlarged heart, ofcongestive aheart varietyfailure, knownor tocardiovascular bedisease that is accompanied by syncope, dyspnea, or collapse. Indicate onset date, enlargeddiagnosis, heartmedication, orand congestiveany heartcurrent failureslimitation. ElectrocardiogramAn electrocardiogram is required when findings so indicate.
Blood pressure (BP). RecordIf witha eitherdriver springhas hypertension and/or mercuryis columnbeing typemedicated offor sphygo-mo-mano-meterhypertension, he or she should be recertified more frequently. IfAn theindividual blooddiagnosed pressurewith mild hypertension (initial BP is consistentlygreater abovethan 160/90 mm.but Hg.,below further181/105) testsmayshould be necessarycertified todeterminefor whetherone the3-month driverperiod isand qualifiedshould tobe operaterecertified aon commercialan motorannual vehicle.
Lungs.basis Ifthereafter anyif lunghis diseaseor her BP is detected,reduced. stateAn whetherindividual activediagnosed orwith arrested;moderate ifto arrested,severe yourhypertension opinion(initial asBP tois howgreater longthan it180/104) hasshould beennot quiescent.
Gastrointestinalbe system.certified Noteuntil anythe diseasesBP ofhas been reduced to the gastrointestinalmild systemrange (below 181/105).
Abdomen. NoteAt wounds,that injuriestime, scars,a or3-month weaknesscertification ofcan musclesbe ofissued. abdominalOnce wallsthe sufficientdriver tohas interferereduced withhis normalor function.her AnyBP herniato shouldbelow be161/91, notedhe ifor present.she Stateshould howbe longrecertified andevery if6 adequatelymonths contained by trussthereafter.
Abnormal masses Lungs. IfNote present,abnormal notechest locationwall expansion, ifrespiratory tenderrate, andbreath whethersounds orincluding notwheezes applicantor knowsalveolar howrales, longimpaired theyrespiratory havefunction, beendyspnea, presentor cyanosis. IfAbnormal thefinds diagnosison suggestsphysical thatexam themay conditionrequire mightfurther interferetesting withsuch theas controlpulmonary tests and/or safex-ray operation of achest.
Abdomen commercialand motorViscera. vehicle,Note moreenlarged stringentliver, testsenlarged mustspleen, beabnormal mademasses, beforebruits, thehernia, applicantand cansignificant beabdominal certified.
Tenderness.wall Whenmuscle noted,weakness state where most pronounced, and suspected causetenderness. If the diagnosis suggests that the condition might interfere with the control and safe operation of a commercial motor vehicle, morefurther stringenttesting testsand mustevaluation beis made before the applicant can be certifiedrequired.
Genito Genital-urinary and rectal examination. UrinalysisA urinalysis is required. AcuteProtein, infectionsblood ofor thesugar genito-urinaryin tract,the asurine definedmay bybe localan andindication Statefor publicfurther healthtesting laws,to indicationsrule fromout urinalysisany ofunderlying uncontrolledmedical diabetes,problems. symptomaticNote albumin-ureahernias. inA thecondition urine,causing ordiscomfort othershould findingsbe indicativeevaluated ofto healthdetermine conditionsthe likelyextent to which the condition might interfere with the control and safe operation of a commercial motor vehicle.
Neurological. Note impaired equilibrium, willcoordination, disqualifyor anspeech applicantpattern; fromparesthesia; operatingasymmetric adeep motortendon vehiclereflexes; sensory or positional abnormalities; abnormal patellar and Babinski's reflexes; ataxia.
Neurological. IfAbnormal positiveneurological Rombergresponses ismay reported,be indicatean degreesindication offor impairmentfurther testing to rule out an underlying medical condition. PupillaryAny reflexesneurological condition should be reportedevaluated for boththe lightnature and accommodation.severity Kneeof jerksthe arecondition, tothe bedegree reportedof absentlimitation onlypresent, whenthe notlikelihood obtainableof uponprogressive reinforcementlimitation, and asthe increasedpotential whenfor footsudden isincapacitation. actuallyIn liftedinstances fromwhere the floormedical followingexaminer has determined that more frequent monitoring of a lightcondition blowis onappropriate, thea patellacertificate for a shorter period should be issued.
Spine, sensorymusculoskeletal. vibratoryPrevious andsurgery, positionaldeformities, abnormalitieslimitation of motion, and tenderness should be noted. Findings may indicate additional testing and evaluation should be conducted.
Extremities. Carefully examine upper and lower extremities. Recordand thenote any loss ofor impairment of a leg, foot, toe, arm, hand, or fingersfinger. Note any and all deformities, the presence of atrophy, semiparalysisparalysis, orpartial paralysis, orclubbing, varicoseedema, veinsor hypotonia. If a hand or finger deformity exists, determine whether sufficientprehension and power grasp isare presentsufficient to enable the driver to securemaintain steering wheel grip and maintainto acontrol gripother onvehicle theequipment steeringduring wheelroutine and emergency driving operations. If a foot or leg deformity exists, determine whether sufficient mobility and strength exist to enable the driver to operate pedals properly. ParticularIn attentionthe shouldcase be given to and a record should be made of, any impairmentloss or structuralimpairment defectto an extremity which may interfere with the driver's ability to operate a commercial motor vehicle safely.
Spine. Note deformities, limitationthe ofmedical motion,examiner orshould anystate historyon ofthe pain,medical injuries,certificate or“medically disease,unqualified pastunless oraccompanied presentlyby experienceda inSkill thePerformance cervicalEvaluation or lumbar spine regionCertificate.” IfThe findingsdriver somust dictate,then radiologicapply and other examinations should be used to diagnosethe congenitalField orService acquiredCenter defects;of orthe spondylolisthesisFMCSA, andfor scoliosis.
Recto-genital studies. Diseases or conditions causing discomfort should be evaluated carefully to determine the extentState toin which the conditiondriver mighthas belegal handicapping while liftingresidence, pulling,for ora duringSkill periodsPerformance ofEvaluation prolongedCertificate drivingunder that§ might be necessary as part of the driver's duties391.49.
Laboratory and otherOther special findingsTesting. UrinalysisOther istest(s) required,may asbe wellindicated asbased suchupon other tests as the medical history or findings uponof physical examination may indicate are necessary. A serological test is required if the applicant has a history of luetic infection or present physical findings indicate the possibility of latent syphilisexamination. Other studies deemed advisable may be ordered by the examining medical examiner.
Diabetes. If insulin is necessary to control a diabetic driver's condition, the driver is not qualified to operate a commercial motor vehicle in interstate commerce. If mild diabetes is notedpresent at the time of examination and it is stabilizedbycontrolled by use of ahypoglycemican oral hypoglycemic drug and/or a diet thatand can be obtained while the driver is on dutyexercise, it should not be considered disqualifying. However, the driver must remain under adequate medical supervision.
TheUpon completion of the examination, the medical examiner must date and sign the form, provide his/her findingsfull uponname, completionoffice ofaddress theand examinationtelephone number.
Examination toThe Determinecompleted Physicalmedical Conditionexamination ofform Drivers
Driver'sshall namebe _____retained □on Newfile Certification
Addressat ________the □office Recertification
Social Security No. ______
Date of birththe _____medical Age __examiner.
Yes No Health[Figure History
□ □ Head or spinalgraphic injuriesomitted.
□ □ Seizures, fits,See convulsions,the orofficial faintingsource.]
□ □ Extensive[Figure confinement by illness or injury.
□ □ Cardiovasculargraphic diseaseomitted.
□ □ Tuberculosis.
□ □ Syphilis.
□ □ Gonorrhea.
□ □ Diabetes.
□ □ Gastrointestinal ulcer.
□ □ NervousSee stomach.
□ □ Rheumaticthe fever.
□ □ Asthma.
□ □ Kidneyofficial diseasesource.]
□ □ Muscular[Figure disease.
□ □ Sufferingor fromgraphic any other diseaseomitted.
□ □ Permanent defectSee fromthe illness,official disease or injurysource.]
□ □ Psychiatric[Figure disorder.
□ □ Anyor othergraphic nervous disorderomitted.
If answerSee to any of the aboveofficial is yes, explain:source.]
physical[Figure examination
Generalor appearancegraphic and development:
Good __ Fair __ Poor __
Vision: For distance:
Right 20/ __ Left 20/ __
□ Without corrective lensesomitted.
□ WithSee correctivethe lensesofficial if wornsource.]
Evidence[Figure of disease or injury:
Rightgraphic __omitted. LeftSee __
Colorthe Testofficial ________________source.]
Horizontal[Figure field of vision:
Right __° Left __°
Hearing:
Right ear __ Left ear __
Disease or injurygraphic _____________
Audiometric Test (complete only if audiometer is used to test hearing) decibel loss as 500 Hz __, at 1,000 Hz __, at 2,000 Hz __
Throat ___________________
Thorax:
Heart ___________________
If organic disease is present, is it fully comp-ensated? ____________
Blood pressure:
Systolic __ Diastolic __
Pulse: Before exercise _______
Immediately after exercise ______
Lungs ____________
Abdomen:
Scars __ Abnormal masses __
Tenderness __
Hernia: Yes __ No __
If so, where? ____________
Is truss worn? ________
Gastrointestinal:
Ulceration or other disease:
Yes __ No __
Genito-Urinary:
Scars ___________________
Urethral discharge ____________
Reflexes:
Romberg _________________
Pupillary __ Light R __ L __
Accommodation Right __ Left __
Knee Jerks:
Right:
Normal __ Increased __ Absent __
Left:
Normal __ Increased __ Absent __
Remarks _________________
Extremities:
Upper ___________________
Lower ___________________
Spine ___________________
Laboratory and other Special Findings:
Urine: Specomitted. Gr.See __the Alb.official __
Sugar __
Other laboratory data (Serology, etcsource.) _______________________]
Radiological[Figure data _____________
Electrocardiograph ____________
General comments _____________
(Date of examination)
(Address of examining medical examiner)
(Name of examining medical examiner (Print) )
(Title)(License or Certificationgraphic Noomitted.)(State)
(Signature ofSee examiningthe medicalofficial examiner)
Note:
This section to be completed only when visual test is conducted by a licensed ophthalmologist or optometristsource.]
(Date of examination)
(Address of ophthalmologist or optometrist)
(Name of ophthalmologist or optometrist (Print) )
(Signature of ophthalmologist or optometrist)
(g) If the medical examiner finds that the person he/she examined is physically qualified to drive a commercial motor vehicle in accordance with § 391.41(b), he/shethe medical examiner shall complete a certificate in the form prescribed in paragraph (gh) of this section and furnish one copy to the person who was examined and one copy to the motor carrier that employs him/her.
(h) The medical examiner's certificate shall be substantially in accordance with the following form. Existing forms may be used until current printed supplies are depleted or until MarchNovember 316, 19972001, providedwhichever thatoccurs the medical examiner writes down in pen and ink any applicable information contained in the following form:first.
Medical[Figure Examiner'sor Certificate
Igraphic certify that I have examined
(Driver's Name—Print)
In accordance with the Federal Motor Carrier Safety Regulations (49 CFR 391omitted.41 throughSee 391.49) and with knowledge of his/her duties, I find him/her qualified under the regulations.
_Qualifiedofficial only when wearing corrective lenses
_Qualified only when wearing a hearing aid
_Qualified by operation of 49 CFR 391source.64]
_Medically unqualified unless accompanied by a ___ waiver
_Medically unqualified unless driving within an exempt intracity zone
A completed examination form for this person is on file in my office.
Area Code & Telephone Number
(License or Certificate No.)
(State in Which Licensed)
(Expiration Date)
(Name & Title of Medical Examiner—Print)
(Signature of Medical Examiner)
(Signature of Driver)
(Address of Driver)
[35 FR 6460, Apr. 22, 1970]
Editorial Note:
For Federal Register citations affecting § 391.43, see the List of CFR Sections Affected, which appears in the Finding Aids section of thisthe printed volume and on GPO Access.