§ 391.43 Medical examination; certificate of physical examination.

(a)(1) Except as provided by paragraph (b) of this section, the medical examination shallmust be performed by a licensed medical examiner aslisted definedon inthe §National 390.5Registry of thisCertified subchapter.
(2)Medical TheExaminers drugunder use verification procedures required by subpart HD needof notpart be390 performed by or under the supervision of thethis medical examinerchapter. If not performed, the medical examiner shall assess compliance with § 391.41
(b) Exceptions:
(121) basedA onlicensed his/herophthalmologist observations, statements of the applicant and/or any tests performed.
(b) A licensed optometrist may perform sothe muchpart of the medical examination asthat pertainsinvolves to visual acuity, field of vision, and the ability to recognize colors as specified in paragraph (10) of § 391.41(b)(10).
(2) A certified VA medical examiner must only perform medical examinations of veteran operators.
(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.[Reserved]
(f) The medical examination shall be performed, and its results shall be recorded, substantiallyon in accordance with the followingMedical instructionsExamination andReport examinationForm, form.MCSA-5875, Existingset formsout mayin bethis usedparagraph until(f):
(g) currentUpon printedcompletion suppliesof arethe depletedmedical orexamination untilrequired Marchby 31,this 1997.subpart:
Instructions(1) for Performing and Recording Physical Examinations
The examining medical examiner shouldmust reviewdate theseand instructionssign before performing the physicalMedical examination.Examination AnswerReport eachand questionprovide yeshis or noher wherefull appropriate.
Thename, examiningoffice medicaladdress, examiner should be aware of the rigorous physical demands and mentaltelephone andnumber emotional responsibilities placed on the driver of a commercial motor vehicleReport.
(2)(i) InBefore theJune interest23, of2025, publicif safety the examining medical examiner isfinds required to certify that the driverperson doesexamined notis havephysically anyqualified physical, mental, or organic defect of such a nature as to affect the driver's ability to operate safely a commercial motor vehicle.
General information.in Theaccordance purposewith of§ this391.41(b), historyhe andor physicalshe examinationmust iscomplete toa detectcertificate in the presenceform ofprescribed physical,in mental,paragraph or(h) organic defects of suchthis asection character and extentfurnish as to affect the applicant'soriginal ability to operatethe aperson commercialwho motorwas vehicle safelyexamined. The examinationexaminer shouldmust beprovide madea carefullycopy andto ata leastprospective asor completecurrent asemploying indicatedmotor bycarrier thewho attachedrequests formit.
(ii) HistoryOn of certain defects may be cause for rejection or indicateafter theJune need for making certain laboratory tests or a further23, and more stringent2025, examination.if Defectsthe maymedical beexaminer recordedidentifies which do not, because of their character or degree, indicate that certification of physical fitness should be denied. However, these defects should be discussed with the applicantperson andexamined he/shewill shouldnot be advisedoperating to take the necessary steps to insure correction, particularly of those which, if neglected, might lead to a conditioncommercial likelymotor tovehicle affect his/her ability to drive safely.
General appearance and development. Note marked overweight. Note any posture defect, perceptible limp, tremor, or other defects that mightrequires bea causedcommercial bydriver's alcoholism,license thyroid intoxication, or othera illnesses.commercial Thelearner's Federalpermit Motorand Carrierfinds Safety Regulations provide that nothe driver shallis usephysically aqualified narcoticto oroperate othera habit-formingcommercial drugs.
Head-eyes.motor Whenvehicle otherin thanaccordance thewith Snellen§ chart is used391.41(b), thehe resultsor ofshe such test must becomplete expresseda certificate in values comparable to the standardform Snellenprescribed test.in Ifparagraph the(h) applicantof wearsthis correctivesection lenses,and thesefurnish should be worn while applicant's visual acuity is being tested. If appropriate, indicate on the Medicaloriginal Examiner'sto Certificate by checking the box,person “Qualifiedwho onlywas when wearing corrective lensesexamined.” InThe recordingexaminer distancemust visionprovide usea 20copy feetto as normal. Report all vision as a fractionprospective withor 20current asemploying numeratormotor andcarrier thewho smallestrequests type read at 20 feet as denominatorit.
(3) NoteOn ptosis,or discharge,after visualJune fields23, ocular muscle imbalance2025, colorif blindness,the cornealmedical scar,examiner exophtalmos,finds orthat strabismus,the uncorrectedperson byexamined correctiveis lenses. Monocular drivers are not physically qualified to operate a commercial motor vehiclesvehicle underin existingaccordance Federalwith Motor§ Carrier Safety Regulations391. If the driver habitually wears contact lenses41(b), he or intendsshe tomust doinform sothe whileperson driving,examined there should be sufficient evidence to indicate that he/she hasor goodshe tolerance is wellnot adaptedphysically toqualified, theirand use.that Thethis useinformation ofwill contact lenses should be notedreported onto the recordFMCSA.
Ears. NoteAll evidencemedical of mastoid or middle ear disease, discharge, symptoms of aural vertigo, or Meniereexaminer's Syndrome.certificates Whenpreviously recordingissued hearing, record distance from patient at which a forced whispered voice can first be heard. If audiometer is used to testthe hearing,person recordare decibelnot lossvalid at 500 Hz, 1,000 Hz, and 2,000no Hz.
Throat.longer Notesatisfy evidence of disease, irremediable deformities of the throatrequirements likely to interfere with eating or breathing, or any laryngeal condition which could interfere with the safe operation of a§ commercial motor vehicle391.
Thorax-heart41(a).
(4) StethoscopicBeginning examinationDecember is required. Note murmurs and arrhythmias22, and any past or present history of cardiovascular disease2015, ofif athe varietymedical knownexaminer tofinds bethat accompaniedthe bydetermination syncope, dyspnea, collapse, enlarged heart, or congestive heart failures. Electrocardiogram is required when findings so indicate.
Blood pressure. Record with either spring or mercury column type of sphygomomanometer.whether If the bloodperson pressureexamined is consistentlyphysically above 160/90 mm. Hg., further tests may be necessary to determine whether the driver is qualified to operate a commercial motor vehicle.
Lungs. Ifin anyaccordance lung disease is detected, state whether active or arrested; if arrested, your opinion as to how long it has been quiescent.
Gastrointestinal system. Note any diseases of the gastrointestinal system.
Abdomen. Note wounds, injuries, scars, or weakness of muscles of abdominal walls sufficient to interfere with normal§ function391.41(b) Any hernia should be noteddelayed ifto present.receive Stateadditional howinformation long and if adequately contained by truss.
Abnormal masses. If present, note location, if tender, and whether or notto applicantconduct knowsfurther howexamination longin theyorder havefor been present. If the diagnosismedical suggestsexaminer thatto themake conditionsuch might interfere with the control and safe operation of a commercial motor vehicledetermination, morehe stringentor testsshe must beinform made before the applicantperson canexamined be certified.
Tenderness. When noted, state where most pronounced, and suspected cause. If the diagnosis suggests that the conditionadditional mightinformation interfere with the control and safe operation of a commercial motor vehicle, more stringent tests must be madeprovided beforeor the applicantfurther canexamination becompleted certified.
Genito-urinary.within Urinalysis45 is required. Acute infections of the genito-urinary tractdays, as defined by local and Statethat public health laws, indications from urinalysis of uncontrolled diabetes, symptomatic albumin-urea in the urine,pending orstatus other findings indicative of health conditions likely to interfere with the controlexamination and safe operation of a commercial motor vehicle, will disqualify an applicant from operating a motor vehicle.
Neurological. If positive Romberg is reported, indicate degrees of impairment. Pupillary reflexes should be reported for both light and accommodation. Knee jerks are to be reported absent only when not obtainable upon reinforcement and as increased when foot is actually lifted from the floor following a light blow on the patella, sensory vibratory and positional abnormalities should be notedFMCSA.
Extremities.(5)(i)(A) CarefullyOnce examineevery uppercalendar and lower extremities. Record the loss of impairment of a legmonth, foot,beginning toe,May arm21, hand,2014 or fingers. Note any and allending deformities,on theJune presence of atrophy22, semiparalysis or paralysis2018, orthe varicosemedical veins.examiner Ifmust aelectronically handtransmit orto finger deformity existsFMCSA, determinevia whethera sufficient grasp is present to enable the driver to secure andWeb maintainaccount a grip on the steeringNational wheel.Registry, If a legcompleted deformityCMV exists,Driver determineMedical whetherExamination sufficientResults mobilityForm, and strength exist to enable the driver to operate pedals properlyMCSA-5850. ParticularThe attentionForm shouldmust beinclude givenall toinformation andspecified afor recordeach shouldmedical beexamination madeconducted of,during any impairment or structural defect which may interfere with the driver'sprevious abilitymonth tofor operate a commercial motor vehicle safely.
Spine. Note deformities, limitation of motion, or any historydriver ofwho pain,is injuries,required or disease, past or presently experienced in the cervical or lumbar spine region. If findings so dictate, radiologic and other examinations should be used to diagnose congenital or acquired defects; or spondylolisthesis and scoliosis.
Recto-genital studies. Diseases or conditions causing discomfort should be evaluatedexamined carefullyby toa determinemedical theexaminer extentlisted toon which the conditionNational mightRegistry be handicapping while lifting, pulling, or during periods of prolongedCertified drivingMedical that might be necessary as part of the driver's dutiesExaminers.
Laboratory(B) andBeginning otherJune special22, findings.2018 Urinalysisby ismidnight required,(local astime) wellof asthe suchnext othercalendar testsday asafter the medical historyexaminer orcompletes findingsa uponmedical physical examination mayfor indicateany aredriver necessary.who A serological test is required ifto thebe applicantexamined hasby a historymedical ofexaminer lueticlisted infectionon or present physical findings indicate the possibilityNational Registry of latentCertified syphilis.Medical OtherExaminers, studies deemed advisable may be ordered by the examining medical examiner.
Diabetes. Ifmust insulinelectronically istransmit necessary to control a diabetic conditionFMCSA, thevia driver is not qualified to operate a commercialsecure motorFMCSA-designated vehicle.website, If mild diabetes is noted at the time of examination and it is stabilized by use of a hypoglycemiccompleted drugCMV andDriver aMedical dietExamination thatResults can be obtained while the driver is on dutyForm, it should not be considered disqualifyingMCSA-5850. However,The theForm driver must remaininclude underall adequateinformation medicalspecified supervision.
Controlled Substances Testing. If a test for controlledeach substances is performed as part of the medical examination, theconducted medicalfor examinereach isdriver towho checkis therequired box next to thebe statement,examined “Controlledby substances test performed” on the medical examination form. If a test for controlled substances is not performed, the medical examiner islisted toon check the boxNational nextRegistry toof theCertified statement,Medical “ControlledExaminers substancesin testaccordance notwith performed.” If a controlled substances test is performed under the requirementsprovisions of subpart H of this part, then the medical examiner must also check the box next to the statement, “in accordance with subpart HE,” and mustshould obtainalso include information thatfor theeach resultsdriver ofwho suchis testrequired wereby negativea priorState to certifyingbe thatexamined theby driver is otherwise medically qualified. If a controlled substance test is performed but not in accordance with subpart H, the medical examiner mustlisted alsoon check the boxNational nextRegistry toof theCertified statement,Medical “notExaminers in accordance with subpart H,” and ensure that the resultsprovisions of thethis testsubpart were negative prior to certifying that the driver is otherwise medically qualified.
The medical examiner must date and sign his/her findings upon completion of the examination.
Examination to Determine Physical Condition of Drivers
Driver's name _____} New Certification
Address ________} Recertification
Social Security No. ______
Date of birth _____ Age __
Yes No Health History
□ □ Head or spinal injuries.
□ □ Seizures, fits, convulsions, or fainting.
□ □ Extensive confinement by illness or injury.
□ □ Cardiovascular disease.
□ □ Tuberculosis.
□ □ Syphilis.
□ □ Gonorrhea.
□ □ Diabetes.
□ □ Gastrointestinal ulcer.
□ □ Nervous stomach.
□ □ Rheumatic fever.
□ □ Asthma.
□ □ Kidney disease.
□ □ Muscular disease.
□ □ Suffering from any othervariances disease.
□ □ Permanent defect from illness,those diseaseprovisions oradopted injury.
□ □ Psychiatricby disorder.
□ □ Anysuch other nervous disorderState.
If answer to any of the above is yes, explain:
physical examination
General appearance and development:
Good __ Fair __ Poor __
Vision: For distance:
Right 20/ __ Left 20/ __
□ Without corrective lenses.
□ With corrective lenses if worn.
Evidence of disease or injury:
Right __ Left __
Color Test ________________
Horizontal field of vision:
Right __° Left __°
Hearing:
Right ear __ Left ear __
Disease or injury _____________
Audiometric Test (complete only if audiometer is used to test hearingii) decibelBeginning losson asJune 500 Hz __22, at 12015,000 Hzif __,the 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: Spec. Gr. __ Alb. __
Sugar __
Other laboratory data (Serology, etc.) _______________________
Radiological data _____________
Electrocardiograph ____________
Controlled Substances Testing
□ Controlled substances test performed—
□ In accordance with subpart H.
□ Not in accordance with subpart H.
□ Controlled substances test NOT performed.
General comments _____________
(Date of examination)
(Address of examining medical examiner)
(Name ofdoes examiningnot medicalperform examinera (Print)medical )
(Title)(Licenseexamination or Certification No.)(State)
(Signature of examiningany medicaldriver examiner)
Note:
Thiswho sectionis required to be completedexamined only when visual test is conducted by a licensedmedical ophthalmologistexaminer orlisted optometrist.
(Dateon ofthe examination)
(AddressNational ofRegistry ophthalmologist or optometrist)
(Name of ophthalmologistCertified orMedical optometristExaminers (Print)during )
(Signatureany ofcalendar ophthalmologistmonth, or optometrist)
(g) If the medical examiner findsmust report that thefact person he/she examined is physically qualified to driveFMCSA, via a commercialsecure motorFMCSA-designated vehicle in accordance with § 391.41(b)website, he/sheby shall complete a certificate in the formclose prescribed in paragraph (g) of thisbusiness sectionon and furnish one copy to the personlast whoday wasof examinedsuch and one copy to the motor carrier that employs him/hermonth.
(h) The medical examiner's certificate shall be completed in accordance with the following form.Form Existing forms may be used until current printed supplies are depleted or until March 31MCSA-5876, 1997, provided that the medical examiner writes down in pen and ink any applicable information contained in the following form:
Medical Examiner's Certificate:
I certify that I have examined
(Driver's Name—Printi)
In accordanceEach withoriginal the Federal Motor Carrier Safety Regulations (49paper CFRor 391.41 through 391.49electronic) andcompleted withMedical knowledgeExamination ofReport his/herand duties,a Icopy findor him/herelectronic qualifiedversion underof theeach regulations.
—Qualifiedmedical onlyexaminer's whencertificate wearingmust correctivebe lenses
—Qualifiedretained onlyon whenfile wearingat athe hearingoffice aid
—Qualified by operation of 49the CFRmedical 391.64
—Medicallyexaminer unqualifiedfor unlessat accompaniedleast by3 ayears ___from waiver
—Medicallythe unqualifieddate unlessof drivingexamination. withinThe anmedical exemptexaminer intracitymust zone
Amake completedall examinationrecords formand forinformation thisin personthese isfiles onavailable fileto inan myauthorized office.
Arearepresentative Codeof &FMCSA Telephoneor Number
(Licensean orauthorized CertificateFederal, No.)
(State, inor Whichlocal Licensed)
(Expirationenforcement Date)
(Nameagency &representative, Titlewithin of48 Medicalhours Examiner—Print)
(Signatureafter ofthe Medicalrequest Examiner)
(Signatureis of Driver)made.
(Address of Driver)
[35 FR 6460, Apr. 22, 1970,]
Editorial asNote:
For amendedFederal atRegister 35citations FRaffecting 17420,§ Nov391. 13, 1970; 36 FR 8452, May 6, 1971; 36 FR 12857, July 8, 1971; 43 FR 56900, Dec.see 5,the 1978;List 46of FRCFR 53418,Sections Oct. 29Affected, 1981;which 53appears FRin 18057,the MayFinding 19,Aids 1988;section 53of FRthe 47154,printed Nov.volume 21,and 1988;at 54 FR 12202, Marwww. 24, 1989; 55 FR 3555, Febgovinfo. 1, 1990; 57 FR 33278, July 28, 1992; 58 FR 59196, Novgov. 8, 1993; 60 FR 38745, 38746, July 28, 1995; 61 FR 13347, Mar. 26, 1996]