§ 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 advisory criteria prepared by the FMCSA 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 § 391.62 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 Septemberby 30,this 2004, whichever occurs first.subpart:
Instructions(1) for Performing and Recording Physical Examinations
The medical examiner must bedate familiar with 49 CFR 391.41, Physical qualifications for drivers, and shouldsign review these instructions before performing the physicalMedical examination.Examination AnswerReport eachand questionprovide “yes”his or “no”her andfull recordname, numericaloffice readingsaddress, whereand indicatedtelephone number on the physical examination formReport.
The(2)(i) medicalBefore examinerJune must be aware of the rigorous physical23, mental2025, andif emotional demands placed on the driver of a commercial motor vehicle. In the interest of public safety, the medical examiner isfinds required to certify that the driverperson doesexamined notis havephysically anyqualified physical, mental, or organic condition that might affect the driver's ability to operate a commercial motor vehicle safely.
Generalin information.accordance Thewith purpose§ of this history and physical examination is to detect the presence of physical391.41(b), mental,he or organicshe conditionsmust ofcomplete such a charactercertificate and extent as to affect the driver's ability to operate a commercial motor vehicle safely. The examination should be conducted carefully and should at least include all of the information requested in the following form. Historyprescribed ofin certainparagraph conditions(h) may be cause for rejection. Indicate the need for further testing and/or require evaluation by a specialist. Conditions may be recorded which do not, because of theirthis charactersection or degree, indicate that certification of physical fitness should be denied. However, these conditions should be discussed with the driver and he/shefurnish should be advised to take the necessaryoriginal steps to insure correction, particularly of those conditions which, if neglected, might affect the driver'sperson abilitywho towas drive safelyexamined.
General appearanceThe andexaminer development.must Noteprovide markeda overweight.copy Noteto anya posturalprospective defect, perceptible limp, tremor, or othercurrent conditionsemploying thatmotor mightcarrier bewho causedrequests by alcoholism, thyroid intoxication or other illnessesit.
Head-eyes.(ii) WhenOn otheror thanafter theJune Snellen23, chart is used2025, theif results of such test must be expressed in values comparable to the standardmedical Snellenexaminer test.identifies Ifthat the driverperson wearsexamined correctivewill lensesnot for driving, these should be wornoperating whilea driver'scommercial visualmotor acuityvehicle isthat beingrequires tested.a Ifcommercial contact lenses are worn, there should be sufficient evidence of good tolerance of and adaptation to their use. Indicate the driver's needlicense toor weara correctivecommercial lenses to meet the vision standard on the Medical Examinerlearner's Certificatepermit 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 thefinds smallestthat type read at 20 feet as the denominator.driver Monocularis driversphysically are not qualified to operate a commercial motor vehiclesvehicle in interstateaccordance commerce.
Ears.with Note§ evidence of any ear disease391.41(b), symptomshe of aural vertigo, or Meniere'sshe Syndrome.must Whencomplete recording hearing, record distance from patient at which a forcedcertificate whisperedin voice can first be heard. For the whisperedform voiceprescribed test,in theparagraph individual(h) shouldof bethis stationedsection atand leastfurnish 5 feet from the examineroriginal withto the earperson beingwho testedwas turned toward the examinerexamined. The otherexaminer earmust isprovide covered.a Usingcopy theto breath which remains after a normalprospective expiration, the examiner whispers words or randomcurrent numbersemploying suchmotor ascarrier 66,who 18,requests 23, etcit. The examiner should not use only sibilants
(s-sounding test materials3). TheOn oppositeor earafter shouldJune be23, tested2025, inif the samemedical manner.examiner Iffinds thethat individual fails the whisperedperson voiceexamined test,is thenot audiometricphysically testqualified shouldto beoperate administered.a Forcommercial themotor audiometricvehicle test,in recordaccordance decibelwith loss§ at 500 Hz, 1,000 Hz, and 2,000 Hz391. Average the decibel loss at 500 Hz41(b), 1,000he Hzor andshe 2,000must Hzinform and record as described on the form.person Ifexamined thethat individualhe failsor theshe audiometricis test and the whispered voice test has not beenphysically administeredqualified, theand whisperedthat voicethis testinformation shouldwill be performedreported to determine if the standard applicable to that test can be metFMCSA.
Throat. NoteAll anymedical irremediableexaminer's deformitiescertificates likelypreviously issued to interferethe withperson breathingare ornot swallowing.
Heart.valid Note murmurs and arrhythmias,no andlonger anysatisfy historythe requirements of an§ enlarged heart, congestive heart failure, or cardiovascular disease that is accompanied by syncope, dyspnea, or collapse391. Indicate onset date, diagnosis, medication, and any current limitation41(a). An electrocardiogram is required when findings so indicate.
Blood pressure (BP4). IfBeginning aDecember driver22, has hypertension and/or is being medicated for hypertension2015, heif orthe shemedical shouldexaminer befinds recertifiedthat morethe frequently.determination Anof individualwhether diagnosedthe withperson Stageexamined 1 hypertension (BP is 140/90-159/99)physically mayqualified be certified for one year. At recertification, an individual with a BP equal to oroperate less than 140/90 may be certified for one year; however, if his or her BP is greater than 140/90 but less than 160/100, a one-timecommercial certificatemotor forvehicle 3in monthsaccordance can be issued. An individual diagnosed with Stage§ 2 391.41(BP is 160/100-179/109b) should be treateddelayed andto areceive one-timeadditional certificateinformation foror 3-monthto certificationconduct canfurther beexamination issued.in Onceorder for the drivermedical hasexaminer reduced his or her BP to equalmake tosuch or less than 140/90determination, he or she maymust beinform recertifiedthe annuallyperson thereafter.examined Anthat individualthe diagnosedadditional withinformation Stagemust 3be hypertensionprovided (BP equal to or greaterthe thanfurther 180/110)examination shouldcompleted notwithin be45 certifieddays, untiland histhat orthe herpending BPstatus isof reducedthe toexamination 140/90will or less, and may be recertifiedreported everyto 6 monthsFMCSA.
Lungs.(5)(i)(A) NoteOnce abnormalevery chestcalendar wall expansionmonth, respiratorybeginning rate,May breath sounds including wheezes or alveolar rales21, impaired2014 respiratoryand function,ending dyspnea, or cyanosis. Abnormal finds on physicalJune exam may require further testing such as pulmonary tests and/or x-ray of chest.
Abdomen and Viscera. Note enlarged liver22, enlarged spleen2018, abnormalthe masses,medical bruits,examiner hernia,must andelectronically significanttransmit abdominalto wallFMCSA, musclevia weaknessa andsecure tenderness.Web Ifaccount theon diagnosis suggests that the conditionNational mightRegistry, interferea withcompleted theCMV controlDriver andMedical safeExamination operationResults of a commercial motor vehicleForm, further testing and evaluation is required.
GenitalMCSA-urinary and rectal examination5850. AThe urinalysisForm ismust required.include Protein,all bloodinformation orspecified sugarfor ineach themedical urineexamination mayconducted beduring anthe indicationprevious month for further testing to rule out any underlyingdriver medicalwho problems.is Noterequired hernias.to A condition causing discomfort should be evaluatedexamined toby determinea themedical extentexaminer tolisted whichon the conditionNational mightRegistry interfere with the control and safe operation of aCertified commercialMedical motor vehicleExaminers.
Neurological.(B) NoteBeginning impairedJune equilibrium22, coordination,2018 orby speechmidnight pattern;(local paresthesia;time) asymmetricof deepthe tendonnext reflexes;calendar sensoryday orafter positionalthe abnormalities;medical abnormalexaminer patellarcompletes anda Babinski'smedical reflexes;examination ataxia.for Abnormalany neurologicaldriver responseswho mayis berequired an indication for further testing to rulebe outexamined anby underlyinga medical condition.examiner Anylisted neurologicalon condition should be evaluated for the natureNational andRegistry severity of theCertified condition,Medical the degree of limitation presentExaminers, the likelihood of progressive limitation, and the potential for sudden incapacitation. In instances where the medical examiner hasmust determinedelectronically thattransmit moreto frequentFMCSA, monitoringvia of a conditionsecure isFMCSA-designated appropriatewebsite, a certificatecompleted forCMV aDriver shorterMedical periodExamination shouldResults be issued.
SpineForm, musculoskeletalMCSA-5850. PreviousThe surgery,Form deformities,must limitationinclude ofall motion,information andspecified tendernessfor shouldeach bemedical noted.examination Findings may indicate additional testing and evaluation should be conducted.
Extremities. Carefullyfor examineeach upper and lower extremities and note any loss or impairment of leg, foot, toe, arm, hand, or finger. Note any deformities, atrophy, paralysis, partial paralysis, clubbing, edema, or hypotonia. If a hand or finger deformity exists, determine whether prehension and power grasp are sufficient to enable the driver towho maintainis steeringrequired wheel grip and to controlbe otherexamined vehicleby equipment during routine and emergency driving operations. If a footmedical orexaminer leglisted deformityon exists, determine whether sufficient mobility and strength exist to enable the driverNational toRegistry operate pedals properly. In the case of anyCertified lossMedical orExaminers impairmentin toaccordance an extremity which may interfere with the driver'sprovisions abilityof tothis operatesubpart a commercial motor vehicle safelyE, theand medical examiner should statealso oninclude theinformation medicalfor certificateeach “medicallydriver unqualifiedwho unlessis accompaniedrequired by a SkillState Performanceto Evaluationbe Certificate.”examined Theby drivera mustmedical thenexaminer applylisted toon the FieldNational ServiceRegistry Center of theCertified FMCSA,Medical forExaminers the State in whichaccordance with the driverprovisions hasof legalthis residence,subpart forand aany Skillvariances Performancefrom Evaluationthose Certificateprovisions underadopted §by 391.49.
Laboratorysuch and Other TestingState. Other test
(sii) mayBeginning beon indicatedJune based22, upon2015, if the medical historyexaminer ordoes findingsnot ofperform thea physicalmedical examination.
Diabetes. Ifof insulinany is necessary to control a diabetic driver's condition,who the driver is notrequired qualified to operatebe aexamined commercial motor vehicle in interstate commerce. If mild diabetes is present and it is controlled by usea ofmedical anexaminer orallisted hypoglycemicon drug and/or diet and exercise, it should not be considered disqualifying. However, the driverNational mustRegistry remainof underCertified adequateMedical medicalExaminers supervision.
Uponduring completionany ofcalendar the examinationmonth, the medical examiner must datereport andthat signfact theto formFMCSA, providevia his/hera fullsecure nameFMCSA-designated website, officeby address and telephone number. The completed medical examination form shall be retained on file at the officeclose of thebusiness medicalon examiner.
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(gh)(1) IfThe the medical examiner's findscertificate thatshall thebe personcompleted examined is physically qualified to operate a commercial motor vehicle in accordance with § 391.41(b), the medicalfollowing examinerForm shouldMCSA-5876, completeMedical aExaminer's certificate in the form prescribed in paragraph Certificate:
(hi) ofEach this section and furnish the original to(paper theor personelectronic) whocompleted wasMedical examined.Examination TheReport examinerand may provide a copy to a prospective or currentelectronic employingversion motorof carriereach who requests it.
(2) For all drivers examined, the medical examiner's shouldcertificate retainmust abe copyretained ofon thefile Medical Examination Report at least 3 years from the dateoffice of the examination. If the driver was certified as physically qualified, then the medical examiner should also retain the medical certificate as well for at least 3- years from the date theof certificate was issuedexamination.
(h) The medical examiner's certificatemust shallmake beall substantiallyrecords inand accordanceinformation within thethese followingfiles form.available Existingto formsan mayauthorized berepresentative usedof untilFMCSA currentor printedan suppliesauthorized areFederal, depletedState, or untillocal Novemberenforcement 6,agency 2001representative, whicheverwithin occurs48 first.
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[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 the printed volume and onat GPO Accesswww.govinfo.gov.