§ 391.43 Medical examination; certificate of physical examination.

(a) Except as provided by paragraph (b) of this section and as provided by § 391.42, the medical examination must be performed by a medical examiner listed on the National Registry of Certified Medical Examiners under subpart D of part 390 of this chapter.
(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 3 hypertension (BP equal to or greater than 180/110) should not be certifiedprovided until his or herthe BPfurther isexamination reducedcompleted towithin 140/9045 or lessdays, and maythat bethe recertifiedpending everystatus 6of months.
Lungs.the Noteexamination abnormalwill chestbe wallreported expansion,to respiratory rate, breath sounds including wheezes or alveolar rales, impaired respiratory function, dyspnea, or cyanosisFMCSA. Abnormal finds on physical exam may require further testing such as pulmonary tests and/or x-ray of chest.
Abdomen(5)(i)(A) andOnce Viscera.every Notecalendar enlarged livermonth, enlargedbeginning spleen,May abnormal masses21, bruits,2014 hernia, and significantending abdominalon wallJune muscle weakness and tenderness. If the diagnosis suggests that the condition might interfere with the control and safe operation of a commercial motor vehicle22, further testing and evaluation is required.
Genital-urinary and rectal examination. A urinalysis is required. Protein2018, blood or sugar in the urine may be an indication for further testing to rule out any underlying medical problems.examiner Notemust hernias.electronically Atransmit condition causing discomfort should be evaluated to determineFMCSA, thevia extenta tosecure whichWeb theaccount conditionon might interfere with the controlNational andRegistry, safe operation of a commercialcompleted motorCMV vehicle.
Neurological.Driver NoteMedical impairedExamination equilibrium,Results coordinationForm, orMCSA-5850. speechThe pattern;Form paresthesia;must asymmetricinclude deepall tendoninformation reflexes;specified sensoryfor oreach positionalmedical abnormalities;examination abnormalconducted patellarduring andthe Babinski'sprevious reflexes;month 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 theExaminers.
(B) degreeBeginning ofJune limitation present22, the2018 likelihoodby ofmidnight progressive(local limitation,time) andof the potentialnext forcalendar suddenday incapacitation.after In instances where the medical examiner hascompletes determined that more frequent monitoring of a conditionmedical isexamination appropriate, a certificate for a shorter period should be issued.
Spine, musculoskeletal. Previous surgery, deformities, limitation of motion, and tenderness should be noted. Findings may indicate additional testing and evaluation should be conducted.
Extremities. Carefully examine 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 or impairment to an extremity which may interfere with the driver's ability to operate a commercial motor vehicle safelyExaminers, the medical examiner should state on the medical certificate “medically unqualified unless accompanied by a Skill Performance Evaluation Certificate.” The driver must thenelectronically applytransmit to the Field Service Center of the FMCSA, forvia thea Statesecure inFMCSA-designated which the driver has legal residencewebsite, for a Skillcompleted PerformanceCMV EvaluationDriver CertificateMedical underExamination § 391.49.
LaboratoryResults andForm, other testingMCSA-5850. OtherThe test(s)Form maymust beinclude indicatedall basedinformation uponspecified thefor each medical history or findings of the physical examination.
Diabetes. Ifconducted insulinfor iseach 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 remain under adequate medical supervision.
Upon completion of theCertified examination,Medical theExaminers medicalin examineraccordance mustwith date and sign the form,provisions provideof his/herthis fullsubpart nameE, office address and telephoneshould number.also Theinclude completedinformation medicalfor examinationeach formdriver shallwho beis retainedrequired onby filea atState theto officebe ofexamined theby a medical examiner.
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(gii) UponBeginning completionon ofJune the medical examination required by this subpart:
(1) The medical examiner must date and sign the Medical Examination Report and provide his or her full name22, office address2015, andif telephone number on the Report.
(2) If the medical examiner findsdoes thatnot theperform person examined is physically qualified to operate a commercialmedical motorexamination vehicle in accordance with § 391.41(b), he or she must complete a certificate in the form prescribed in paragraph (h) of thisany sectiondriver andwho furnishis therequired original to thebe person who was examined. Theby examiner must provide a copymedical toexaminer alisted prospectiveon orthe currentNational employingRegistry motorof carrierCertified whoMedical requestsExaminers it.
(3)during Onceany every calendar month, beginning May 21, 2014, the medical examiner must electronicallyreport transmitthat fact to the DirectorFMCSA, Office of Carrier, Driver and Vehicle Safety Standards, via a secure FMCSA-designated Web sitewebsite, aby completedthe Formclose MCSA-5850, Medical Examiner Submission of CMVbusiness Driver Medical Examination Results. The Form must include all information specified for each medical examination conducted during the previous month for any driver who is required to be examined by a medical examiner listed on the Nationallast Registryday of Certifiedsuch Medical Examinersmonth.
(h) The medical examiner's certificate shall be substantiallycompleted in accordance with the following form.
[FigureForm orMCSA-5876, graphicMedical omitted.Examiner's See the official source.]Certificate:
(i) Each original (paper or electronic) completed Medical Examination Report and a copy or electronic version of each medical examiner's certificate must be retained on file at the office of the medical examiner for at least 3 years from the date of examination. The medical examiner must make all records and information in these files available to an authorized representative of FMCSA or an authorized Federal, State, or local enforcement agency representative, within 48 hours after the request is made.
[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 at www.fdsysgovinfo.gov.