§ 391.43 Medical examination; certificate of physical examination.

(a) Except as provided by paragraph (b) of this section, the medical examination shallmust be performed by a licensed medical examiner aslisted definedon inthe §National Registry of Certified Medical Examiners under subpart D of part 390.5 of this subchapterchapter.
(b) Exceptions:
(1) A licensed ophthalmologist or 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 sphygo-mo-mano-meter.whether If the bloodperson pressureexamined is consistentlyphysically above 160/90 mm. Hg., further testsmay be necessary todetermine whether the driver is qualified to operate a commercial motor vehicle.
Lungs. Ifin anyaccordance lungwith disease§ is391.41(b) detected,should statebe whetherdelayed activeto orreceive arrested;additional ifinformation arrested,or your opinion as to howconduct longfurther itexamination hasin beenorder quiescent.
Gastrointestinalfor system. Note any diseases of the gastrointestinalmedical system.
Abdomen.examiner Note wounds, injuries, scars, or weakness of muscles of abdominal walls sufficient to interferemake withsuch normal function. Any hernia should be noted if present. State how long and if adequately contained by truss.
Abnormal masses. If presentdetermination, notehe location, if tender, and whether or notshe applicantmust knowsinform how long they have been present. If the diagnosisperson suggestsexamined 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.
Tenderness.within When45 noteddays, state where most pronounced, and suspected cause. If the diagnosis suggests that the conditionpending mightstatus interfereof with the controlexamination andwill safe operation of a commercial motor vehicle, more stringent tests must be madereported beforeto the applicant can be certifiedFMCSA.
Genito-urinary.(5)(i)(A) UrinalysisOnce isevery required.calendar Acutemonth, infectionsbeginning ofMay the genito-urinary tract21, as2014 defined by local and Stateending publicon healthJune laws22, indications from urinalysis of uncontrolled diabetes2018, symptomatic albumin-urea in the urine,medical orexaminer othermust findingselectronically indicativetransmit of health conditions likely to interfereFMCSA, withvia thea controlsecure andWeb safeaccount operationon ofthe aNational commercial motor vehicleRegistry, will disqualify an applicant from operating a motorcompleted vehicle.
Neurological.CMV IfDriver positiveMedical RombergExamination isResults reportedForm, indicateMCSA-5850. degreesThe ofForm impairment.must Pupillaryinclude reflexesall shouldinformation bespecified reported for botheach lightmedical andexamination accommodation.conducted Kneeduring jerksthe areprevious tomonth befor reportedany absentdriver onlywho when not obtainable upon reinforcement and as increased when foot is actuallyrequired liftedto frombe theexamined floorby following a lightmedical blowexaminer listed on the patella,National sensoryRegistry vibratoryof andCertified positionalMedical abnormalities should be notedExaminers.
Extremities.(B) CarefullyBeginning examineJune upper22, and2018 lowerby extremities.midnight Record(local thetime) loss of impairmentthe ofnext acalendar leg,day foot,after toe, arm, hand, or fingers. Note any and all deformities, the presencemedical ofexaminer atrophy,completes semiparalysis or paralysis, or varicose veins. If a handmedical orexamination fingerfor deformityany exists,driver determinewho whether sufficient grasp is presentrequired to enablebe theexamined driverby toa securemedical andexaminer maintainlisted a grip on the steeringNational wheel.Registry Ifof aCertified legMedical deformity existsExaminers, determine whether sufficient mobility and strength exist to enable the drivermedical toexaminer operatemust pedalselectronically properly.transmit Particular attention should be given to and a record should be made ofFMCSA, anyvia impairment or structural defect which may interfere with the driver's ability to operate a commercialsecure motorFMCSA-designated vehicle safely.
Spine. Note deformitieswebsite, limitationa ofcompleted motion,CMV orDriver anyMedical historyExamination ofResults painForm, injuries, 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.
RectoMCSA-genital studies5850. DiseasesThe orForm conditionsmust causinginclude discomfortall shouldinformation bespecified evaluatedfor carefullyeach to determine the extent to which the condition might be handicapping while lifting, pulling, or during periods of prolonged driving that might be necessary as part of the driver's duties.
Laboratory and other special findings. Urinalysis is required, as well as such other tests as the medical history or findings upon physical examination mayconducted indicatefor areeach necessary.driver Awho serological test is required ifto the applicant has a history of luetic infection or present physical findings indicate the possibility of latent syphilis. Other studies deemed advisable may be orderedexamined by thea examining medical examiner.
Diabetes. Iflisted insulinon is necessary to control a diabetic condition, the driverNational isRegistry notof qualifiedCertified toMedical operateExaminers ain commercialaccordance motorwith vehicle. If mild diabetes is noted at the timeprovisions of examinationthis andsubpart itE, is stabilizedby use of ahypoglycemic drug and ashould dietalso thatinclude caninformation befor obtainedeach while the driver who is onrequired duty,by ita shouldState notto be consideredexamined disqualifying.by However,a the driver must remain under adequate medical supervision.
The medical examiner mustlisted dateon and sign his/her findings upon completion of the examination.
ExaminationNational toRegistry Determine Physical Condition of Drivers
Driver'sCertified nameMedical _____Examiners □in Newaccordance Certification
Addresswith ________the □provisions Recertification
Social Security No. ______
Date of birththis _____subpart Ageand __
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 ____________
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 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 at www.govinfo.gov.