Examen médico; certificado de examen físico.

(a) Excepto según provisto en el inciso (b) de esta sección, el examen médico deberá ser hecho por un doctor en medicina autorizado a ejercer la profesión. (b) Un optómetra licenciado puede llevar a cabo aquella parte del examen médico relativa a la agudeza visual, campo de visión, y la habilidad para reconocer colores según se especifica en el inciso (10) de la Sección 391.41 (b). (c) Los doctores en medicina deberán: (1) Tener conocimiento de las demandas específicas físicas y mentales que están asociadas con la operación de un vehículo de motor comercial y de los requisitos de esta subparte del Reglamento, incluyendo la criteria de asesoramiento médico preparado por la FMCSA como guía para ayudar al médico a tomar la decisión de si la persona está calificada; y 69 (2) Ser competentes y utilizar los protocolos médicos necesarios para realizar adecuadamente los exámenes médicos requeridos por esta sección. (d) Reservada. (e) Reservada (f) El examen médico será llevado a cabo, y sus resultados serán registrados, sustancialmente de acuerdo con las siguientes instrucciones y forma de examen: INSTRUCCIONES PARA LLEVAR A CABO Y REGISTRAR EXÁMENES FÍSICOS El doctor debe de estar familiarizado con la sección 391.41 de este Reglamento y previo a llevar a cabo el examen físico deberá revisar las instrucciones que se ofrecen a continuación Conteste cada pregunta con un Si 0 un No donde sea apropiado, y anotar los resultados donde se indica. El médico debe estar consciente de las rigurosas demandas físicas y responsabilidades emocionales y mentales del conductor de un vehículo de motor comercial. En el interés de la seguridad pública al médico le es requerido certificar que el conductor no tiene un defecto físico, mental u orgánico de tal naturaleza que afecte la habilidad del conductor para operar con seguridad un vehículo de motor comercial. Información general. El propósito de este historial y examen físico es para detectar la presencia de defectos físicos, mentales u orgánicos de tal carácter y extensión que afecten la habilidad del solicitante para operar con seguridad un vehículo de motor comercial. El examen debe ser hecho cuidadosamente y por lo menos tan completo como se indica en el formulario adjunto. Historial de ciertos defectos puede ser causa de rechazo e indicar la necesidad para hacer ciertos exámenes de laboratorio practicarle un examen más completo. Condiciones detectadas 0 aquellas que sean preexistentes pueden ser anotadas aún cuando su estado no conlleve a denegar su Certificado Médico. Sin embargo, estos defectos deben ser discutidos con el solicitante y él debe ser aconsejado para tomar los pasos necesarios para asegurar la corrección, particularmente de aquellos que de ser descuidados, pueden conducir a una condición que pueda afectar su habilidad para manejar con seguridad. 70 Apariencia general y desarrollo. Anote marcado sobrepeso. Anote cualquier defecto en la postura, cojera perceptible, temblor u otros defectos que puedan ser causados por alcoholismo, intoxicación de tiroides y otras enfermedades. Cabeza-ojos. Cuando se utilice una gráfica que no sea la "Snellen", los resultados de dicho examen deben ser expresados en valores comparables a la norma del examen "Snellen". Si el solicitante utiliza lentes correctivos, éstos deben ser usados mientras la agudeza visual del solicitante esté siendo examinada. Si apropiado, indique en el Certificado del Médico Examinador, mediante cotejo del encasillado, "calificado sólo cuando utilice lentes correctivos". Al registrar la distancia de visión utilice veinte pies (20') como normal. Reporte toda visión como fracción con el veinte (20) como numerador y el tipo más pequeño de letra a veinte pies (20') como denominador. Anote "prosis", descarga, campos de visión, desbalance del músculo ocular, ceguera de color, cicatriz de la córnea, exoftalmos, que no sea corregido por los lentes correctivos. Conductores monoculares no están calificados para operar vehículos comerciales de motor bajo las disposiciones de este Reglamento. Si el conductor habitualmente utiliza lentes de contacto, 0 intenta hacerlo mientras maneje, debe existir suficiente evidencia que indique que tiene buena tolerancia y está bien adaptado a su uso. El uso de lentes de contacto debe ser anotado en el registro. Oídos. Anote evidencia de mastoide o enfermedad del oído medio, descarga, síntoma de vértigo aural, o Síndrome de Menier. Cuando registre la audición, registre la distancia desde el paciente en la cual una voz de murmullo forzado puede ser primeramente escuchada. Para el examen de murmullo de voz, el individuo debe de estar parado al menos a cinco pies del examinador con el oído señalando hacia donde se encuentre el examinador. El otro oído es cubierto. Utilizando el aliento que permanece luego de una espiración normal, el examinador susurra palabras o números al azar tales como 66, 18,23, etc. El examinador no deberá utilizar solo materiales sibilantes para probar el sonido. El otro oído debe de ser examinado de la misma manera. Si el individuo falla la prueba de murmullo de voz, se le debe de administrar la prueba audiométrica. Si un audiómetro es utilizado para examinar la audición, registre la pérdida de decibeles a 500 Hz, 1,000 Hz y 2,000 Hz. Describa en la forma la media de pérdida de decibel a 500 Hz, 1,000 Hz y 2,000 Hz. Si el individuo falla el examen audiométrico y el examen de murmullo de voz no ha sido administrado, el 71 examen de murmullo de VOZ debe de ser administrado para determinar si cumple con el estándar aplicable a ese examen. Garganta. Anote la evidencia de enfermedad, deformidades irremediables de la garganta que puedan intervenir con la alimentación 0 respiración, 0 cualquier condición de la laringe que pueda interferir con la operación segura de un vehículo de motor. Tórax-corazón. Examinación estetoscópica es requerida. Anote murmullos y arritmia, y cualquier historial presente 0 pasa do de enfermedades cardiovasculares, de una variedad conocida de venir acompañada de síncope, disnea, colapso, corazón engrandecido o fallas congestivas del corazón. Electrocardiograma es requerido cuando los hallazgos así lo indiquen. Presión de sangre. Si un conductor padece de hipertensión y/o está siendo medicado para la hipertensión, debe de ser recertificado con más frecuencia. El certificado de un individuo diagnosticado con hipertensión leve (presión inicial de la sangre mayor de 140/90 pero menor de 159/99) será válido por un (1) año. En el momento de la recertificación si la presión de la persona es de 140/90 0 menor se le podrá recertificar por un (1) año adicional; no obstante si su presión sobrepasa 140/90 y es menor de 160/100 se le expedirá esta sola vez un certificado con tres (3) meses de duración. Un individuo que se le haya diagnosticado que padece de Hipertensión en su Segunda Etapa (Su presión se encuentra entre 160/100 y 170/109) deberá tratar su condición, en esta situación se le puede expedir un certificado esta única vez por un período de tres (3) meses. Una vez el individuo haya reducido su presión a 140/90 0 menos, podrá ser certificada anualmente. Un individuo diagnosticado con hipertensión severa [tercera etapa], (presión sanguínea de 180/110 0 mayor) no podrá ser certificado hasta tanto la presión de la sangre sea reducida a 140/90 0 menor. Cuando esto ocurra se le podrá emitir una certificación de seis (6) meses puede de duración. Pulmones. Indique si se detecta expansión en el tórax. Anote resultados del ritmo respiratorio, la presencia de sonidos que denoten que se respira con dificultad, anormalidad en los alvéolos, disnea 0 cianosis. La detección de anormalidades en la cavidad pulmonar podría conllevar se practiquen exámenes adicionales, tales como evaluaciones de la función pulmonar y / 0 se soliciten radiografías del tórax. 72 Abdomen y vísceras. Anote agrandamiento del hígado, agrandamiento del bazo, masas anormales, hernias y debilitamiento y ablandamiento significativo de la pared abdominal. Si el diagnóstico sugiere que la condición puede interferir con el control y la operación segura de un vehículo de motor comercial, el individuo deberá someterse a exámenes más rigurosos y se requerirá evaluación. Genito-Urinario y estudios rectales. Se requiere que se administre un urinálisis. La presencia de proteínas, sangre 0 azúcar en la orina podría ser un indicador de que se requiere se administren pruebas adicionales para descartar problemas médicos subyacentes. Indique la presencia de hernias. Cualquier condición que cause incomodidad deberá ser evaluada detenidamente para determinar si esta pudiese interferir con la operación segura de un vehículo de motor comercial. Neurológico. Anote si el equilibrio, la coordinación 0 el patrón del habla están afectados, parestesia, reflejos asimétricos profundos del tendón, anormalidades sensoriales y posicionales, anormalidades en los reflejos patelares (patellar) y Babinski, ataxia. Respuestas neurológicas anormales pueden reflejar la necesidad de que practiquen exámenes más rigurosos para determinar si existe alguna condición médica subyacente en el individuo. A cualquier condición neurológica detectada se le debe evaluar la naturaleza y severidad de la condición, el grado de limitación presente, la probabilidad de limitaciones progresivas, y el potencial de una incapacidad súbita. En instancias en que el médico examinador ha determinado que es apropiado un monitoreo frecuente de una condición se deberá expedir un certificado por un período más corto. Espina. Anote si ha sido sometido a cirugía y la presencia de deformidades, límites en la movilidad, 0 sensibilidad en el área. Detección de alguna de estas condiciones será causa suficiente para someterle a exámenes adicionales. Extremidades. Examine cuidadosamente las extremidades superiores e inferiores. Registre la pérdida de impedimento de una pierna, pié, dedos, brazo 0 mano. Anote cualquiera y todas las deformidades, la presencia de atrofia, semiparálisis, 0 venas varicosas. Si una deformidad en una mano 0 dedo existe, determine si suficiente agarre está presente que permita al conductor mantener y asegurar el agarre en el guía. Si una deformidad en la pierna existe, determine si existe suficiente movilidad y fuerza que permita al conductor operar los pedales adecuadamente. Atención particular debe ser dada a, y un registro debe 73 ser hecho de cualquier impedimento 0 defecto estructural el cual pueda impedimento 0 defecto estructural el cual pueda interferir con la habilidad del conductor para operar un vehiculo de motor con seguridad. Laboratorio y otros hallazgos especiales. Pruebas 0 exámenes adicionales serán administrados basados en el historial médico 0 en descubrimientos basados en las pruebas practicadas para este examen físico. Diabetes. Si la insulina es necesaria para controlar una condición diabética, el conductor no está calificado para conducir un vehículo de motor comercial en el comercio interestatal. Si una diabetes leve es detectada al momento del examen y es estabilizada mediante uso de una droga hipoglicémica, y una dieta que puede ser obtenida mientras el conductor está en servicio, no debe ser considerada descalificante. Sin embargo, el conductor debe permanecer bajo supervisión médica adecuada. Luego de ser completado el examen físico, el médico deberá fechar y firmar el formulario y proveer su nombre completo, dirección de la oficina, número de licencia y número de teléfono. La examinación médica completada debe de ser retenida en los archivos de la oficina del médico. Medical Examination Report FOR COMMERCIAL DRIVER FITNESS DETERMINATION 640-F (6045) 1. DRIVER'S INFORMATION Driver completes this section Driver's Name (Last, First Middle) Social Security No Birthdate Age Sex New Certification Date Exam M Recertification MIDIY F Follow-ve Address City. State, Zip Code Work Tel: ) Driver License No. License Class State issue A C Home Tel , 0 Other 2. HEALTH HISTORY Driver completes this section. but medical examiner is encouraged to discuss with driver. Yes No THE No Yes No LONG thesse emphysems. asthma. chrone bronchis Fairling discripts the haves be blay # - Kisney disease says Shoup discrettes. DRUGH execting Health discribes or Incomes Liver disease will asked divide EXPIRATE Note SECURE application storing Digestive problems - MM Diabetes OF elevated blood sugar controles by: Stroke paradysis Eye discrders CF Insured islum (mm/dd) - offer Missing Impaired hard WTR foot tod. Ear Standers Red Marha failures plis 1 320 Heart divide head other condition Insuin Special any medication Hervous or systems discribers e.g., severe depression medication Chrone low back pain Heart surgery Drive replacements programs) Less of, or altered conselousness Regular ase Hgt Mead present medicalism Name hamit forming chap use - Muscular disness Shortees benefits For any YES answer. indicate onset date. diagnosis, treating physician's name and address. and any current limitation. List all medications (including over-the-counter medications) used regularly or recently. I certify that the above information is complete and true. understand that inaccurate false or missing information may invalidate the examination and my Medical Examiner Certificate Driver's Signature Date Medical Examiner's Comments on Health History (The medical examiner must review and discuss with the driver any "yes" answers and potential hazards of medications, including over-the-counter medications while draving. This discussion must be documented below. 74 TESTING (Medical Examiner completes Section 3 through 7) Name: Last First, Middle 3. VISION Standard: At feast 20/40 acuity (Snellen) in each eye with or without correction. At least 70 degrees peripheral in horizontal meridian measured in each eye. The use of corrective lenses should be noted on the Medical Examiner's Certificate. INSTRUCTIONS: When other than the Sinelled chart is used. give lest results in Snatten-comparable values in recording distance vision, use 20 feet as normal. Report visual aculty as a ratio with 20 as numerator and the smallest type read at 20 feel as denominator If the applicant wears corrective lenses these should be worn while visual aculty is being tested If the oriver habitually wears contact lenses, OF witers to do 80 while driving sufficientexidence of good tolerance and adaptation to their use must be ODVICES. Monocutar drivers are not qualified. Numerical readings must be provided. Applicant can recognize and distinguish among frame control Yes sign als and devices showing standard red, green. and amber colors? No ACUITY UNCORRECTED CORRECTED ADRIZONTAL FIELD OF VISION Right Eye 20/ 20/ Right Eye 0 Applicant meets visual acuity requirement only when wearing: d Corrective Lenses Left Eye 20/ 20/ Left Eye Both Eyes 20/ 20/ Menocular Vision: Yes No Complete next line only if vision testing is done by an opthalmologist or optometnst Date of Examination Name of Ophthalmologist or Optometrist (print) No. License No.) State of issue Signature 4 HEARING Standard: a) Must first perceive forced whispered voice > 5 ft., with or without hearing aid. or b) average hearing loss in better ear ≤ 40 dB Check if hearing aid used for tests. Check if hearing aid required to meet standard INSTRUCTIONS: To convert audimetric test results mom ISO 10 ANSI. -14 CB from ISO for 500MZ. 1005 for 1,000 MI, d5 for 2000 Hz. To average, add the readings to: 3 frequencies tested and divide try 3 Numerical readings must be recorded. Right Ear LeftEer a) Record distance from individual at which Right ear Left Ear b? sudiometer used record nearing loss in SDC HZ 1000 Hz 3000 - 500 HE 1000 MI 2000 42 forced whispered voice can first be heard. Feet (Feet declare (see. to ANSI Average Average 5. BLOOD PRESSURE PULSE RATE Numerical readings must be recorded. Medical Examiner should take at least two readings to confirm BP. Blood Systelic Diastolic Reading Category Expiration Date Recertification Pressure 140-159/90-29 Stage 1 year 1 year f $140.90 One-time certificate for 3 months if Driver qualified if <140/90 141-159/91-92 Pulse Rate Regular Imegular 180-179/100-109 Stage 2 One-time certificate for 3 months. 1 year from date of exam 11/90/90 >150/110 Stage 3 e months from date of exam if <140/90 e months if 140/90 Record Pulse Rate: 6. LABORATORY AND OTHER TEST FINDINGS Numerical readings must be recorded SP. GR. PROTEIN BLOOD SUGAR URINE SPECIMEN Urinalysis is required. Protein. blood or sugar in the urine may be an Indication for further testing to rule out any underlying mesical protlem. Other Testing (Describe and record) 7. PHYSICAL EXAMINATION Height: (in.) Weight: (lbs Name. Last First Middle. The presence of a certain condition may not necessarily disquality a griver, particularly if the consition is controlled adequately. Is not a to worsen b. is readity amenable 10 treatment Even #a condition 0005 not disquality driver. the medical examber may consider deferenting the driver temporarily. Also, the driver should be advised to * the necessary steps to correct the condition as scon as possible particularly If the condition, If neglected, could result m more serious liness that might affect crving. Check YES # there are any acnormatities. Check NO lifthe body system Is noma Discuss any YES answers in detail In the space below. and molcate whethern would affect the driver's ability 00 operate a commercial motor vehicle safely. Enter applicable item number before each comment. If organic disease IS present. note that It has been compensates for. See instructions to the Medical Examiner for guidance. BODY SYSTEM CHECK FOR TEXA NO BODY SYSTEM CHECK FOR: YES' NO 1. General Appearance Marked overweight, tremor. signs of alcoholism problem drinking or drug abuse. 7. Abdomen and Viscere Enlarged Iver, enlarged spleen. masses. trains hemls significant acdeminal not muscle 2. Eyes Pupliary equality. reaction to sight, accommodation, ocutar weakness. monthly. ocular muscle imbalance extraccular movement. 8. Vascular system Abnormatiquise and amployee, carted or mystagmus. exceptination. Ask about retinopating, cataracts, arteris bruits varizose veins. aphake, glavcome massiar degeneration and refer 10 a specialist # appropriate 9. Gentto-urmary System Herniss 3. Ears Scarring of tympanic membrane, occusion of external canal, 10. Extremities- LITE Loss or impairment of leg. foot, lee. are hand. perforated eardrums. impared Driver may finger Perceptible EMA determities, atrophy. 4. Mouth and Throat be subject SPE weakness corsiysis. cleating adams, certificate otherwise hypolonia. insufficient grasp and arehension irrementable deformities skely to interfere with breathing or . upper dmb to maintain steening wheel grip swallowing qualified. ins informent mobily and strengin in lower tmb to operate DE date property. S. Heart Mummurs, extra sounds. entarged neart, pacemaker, imprantable defibriliator 11. Opine, other Previous surgery determines Instruction of musculoskeletal meason tendemers. 6. Lungs and chest Abnormal chest wall expansion, abnormal respiratory rate, impaires or speech not including breast abnormal breath sounds including wheezes or alvector rales 12. Neurological patiern: asymmetric deep tenden reflexes examination impaired respiratory function, evanosis. Abnormal findings on sensory or postions abnormatives. abronmal physical exam may require further testing such 25 patraonary pateller and Babint's referes siste tests and or way of chest. *COMMENTS: Note certification status here. See instructions to the Medical Examiner for guidance Wearing corrective lense Wearing hearing and Meets standards in 49 CFR 391 A1: qualifies for 2 year certificate Accompanied by a waver exemption. Driver must present Does net meet standards exemption at one of certification Meals standards. DR periodic menhoring required due to CAM Performance Evaluation (SPE) Certificate Driver qualified only for: as months months year Other Driving within an exempt intracity zone (See 49 CFR 391.62) Qualified by operation or 49 CFR 391.64 Menical Examiner's signature Temporadiy disqualified due to (condition or medication): Medical Examiner's name Address Return to medical examiner's office for follow up on Telephone Number If meets stendards, complete Medical Examiner's Certificate ** stated in 4# OFR 0.51.48(h). receiver must carry certificate operating 1 commercial vehicle) 75 49 CFR 391.41 Physical Qualifications for Drivers THE DRIVER'S ROLE Responsibilidles, work schedules, physical and emotional demands, and lifestyles among commercial drivers vary by the type of driving that they do. Some of the main types of drivers Include the following: turn around or short relay (drivers return to their home base each evening): long relay (drivers drive 0-11 hours and then have at least a 10-hour off-duty period). straight through haul (cross country drivers) and team drivers (drivers share the driving by alternating their 5-hour driving periods and 5-hour rest periods.) The following factors may be involved In a driver's performance of duties: abrupt schedule changes and rotating work schedules. which may result in irregular sleep patterns and a driver beginning a trip in a faligued condition; long hours: extended time away from family and friends, which may result In tack of social support; tight pickup and delivery schedules, with irregularity in work. rest. and eating patterns, adverse road. weather and traffic conditions, which may cause delays and lead to hurriedly loading or unloading cargo in order to compensate for the lost time: and environmental conditions such as excessive vibration noise. and extremes in temperature. Transporting passengers or hazardous materials may add to the demands on the commercial driver. There may be duties in addition to the driving task for which a driver is responsible and needs to be fit. Some of these responsibilities are: coupling and uncoupling trailer(s) from the tractor. loading and unloading trailer(s) (sometimes a driver may lift a heavy load or unioad 25 much as 50.000 lbs. of freight after sitting for a long period of time without any stretching period): inspecting the operating condition of tractor and/or trailers) before during and after delivery of cargo: lifting. installing. and removing heavy tire chains: and. lifting heavy tarpaulins to cover open top trailers. The above tasks demand agility the ability to bend and steop, the ability to maintain a crouching position to inspect the underside of the vehicle, frequent entering and exiting of the cab, and the ability to climb ladders on the tracter and/or trailer(s). in addition, & driver must have the perceptual skills to monitor 2 sometimes complex driving situation, the judgement skills to make quick decisions, when necessary. and the manipulative skills to control an oversize steering wheel, shift ge using a manual transmission and maneuver a vehicle in crowded areas $391.45 PHYSICAL QUALIFICATIONS FOR DRIVERS (12) (1) Does not use a controlled (7) Has no established medical metory or clinical is A person shall not drive a commerctal motor vehicle unless he substance identified in 21 CPR 1308.11 Schedule diagnosis of meum: arthoris, orthopedic. muscular. is physically qualified to do so and, except as provided m 5391 67. neuromuscular. or vascelar disease which Interieres with nis I, an amphetamine 3 narcotic or any other has on his person the original, or a photographic copy, of medical ability to control and operate a commercial motor vehicle safety. habil-forming drug. (11) Exception: A driver may examiner's certificate that ne is physicany qualified to drive a use such substance or drug. If the substance or (8) Has no established medicalin or clinical commercial motor vehicle. diagnosis of epliepsy or any other condition which IE likely to drug Is prescribed by a licensed medical (D) A person is physically qualified to drive 2 motor vehicle If that cause loss of consciossness or any loss of applity to control a practitioner (A) is familar with the driver's person: medical history and assigned dulles: and (B) Has commercial motor vehicle: (1) Has no loss or a foot leg. a hano, or an BITH or has been advised the driver that the prescribed substance (9) Has no mental. nervous. organic, or functional granted : Skill Performance Evaluation (SPE) Certificate (formerry disease or psychiatric disorder Ekely to Interfere with DIE ability or drug will not adversely affective divers ability Limb Walver Program) pursuant to 5391 49. to safety operate a a mater vehicle; and to drive # commercial motor vehicle safely: (2) Has no Impairment of: (f) hand or finger which interteres (10) M35 distant visual acutty of at least 2040 (Sheten) (13) Has no current citnical diagnosis of with prenension or power grasping or (8) An arm, foot. or leg which alcoholism. in each eye without corrective lenses or visual aculty separately Interferes with the ability to perform normal LIERS associated with corrected to 20/40 (Snetten) or better with corrective lenses. operating a commercial motor vehicle; or any other significant limb distant Direcular acuny of = least 20/40 (Snellen) n both eyes defect or limitation which interferes with the ability 10 perform norma with OT without corrective lenses. fishd of vision of at least 70 lasks associated WE operating a commercial motor vehicle or has degrees in the horizontal meadian in each eye. and the ability been granted a 3PE certificate pursuant to 439 49. 10 reacgnize the colors of traffle signals and devices showing (3) Has no established medical history or clinical diagnosis or standard red, green and amter clabetes meltars currently requiring Insults for control (11) First perceives a TOPORTO whispered voice h the (4) Has no current circical diagnosis of reyocardial Infarction better ear not less than 5 feet with or without the use of a angina pectoris. coronary insufficiency. thrombosis, or any other hearing ald. or tested by use of an audiometric device, 10E$ carbovascular disease of a variety known to be accompanted by not have an average hearing 1055 in the Deder ear greater than syncope dyspnea, collapse. OF congestive cardiac tallure 40 decibets at 500 HZ 1,000 Hz and 2.000 HZ was or without (5) Has no established medical history or clinical diagnosis of a hearing device when the audometric device IS callbrates to the respiratory systunction likely to Intertere with his ability to control and American National Standard (formerly ASA Standard) drive A commercial motor vehicle safely. 224.5-1951: (5) Has no current cinical diagnosis of high blood pressure likely to intertere with his ability to operate a commercial motor vehicle serely. INSTRUCTIONS TO THE MEDICAL EXAMINER General Information Federal Motor Carrier safely aguistions The purpose of this examination 16 to distermine a drivers physical Advisory Orlieriaqualification to operate a commercial motor vehicle (CMV) in Imerstate Disbetes commerce according to the requirements in 49 CFR 391 41-49 Therefore, Loss of Limb: USD 41(b)(3) the medical examiner must DE knowledgeable of these requirements and person $ physically que Hed to the commercial motor guidelines developed by the FMCS to assist the medical examiner in A person physicaly qualited = drive a commercial-mater vehicle that person: vehic that DIRECT making the qualification determination The medical examiner should be Has 40 established medical natory or caster diagnosis of Has DE loss a foot, leg. hand on area. or has been familiar with the driver's responsibilities ano work environment and is d'aberes medities currently requiring Insurance for control. granted SAM Performance Evaluation ISPE) Certificate Disbers melicat 3 disease which, CR occasion, can referred to the section on the form. The Driver's Role cursuant to Better 331.59. result a bys disconsclousness OF disorientation in time 71 addition to reclewing the Health History section with the driver and and souce. Individuals who require insurance CORTO have conducting the physical camination the medical examiner should discuss LIMD impairment conditions a COR get out of central by the use of 333 common prescriptions and over-the-counter medications relative to the side 9391 47(b)(2) much = the Insult or 1003 mase not consistem with effects and hazaros of these medications while driving. Educate the griver cerson 13 anysicate quairled :D drove 0 commercial mater the Marin desage. intepactation may OCCUR from vehicle that person: to read warning lapels on all medications History of certain consitions may SYMPTOMS of hyperglycemic or hypegiyce reactions Has no imparment of: 15 name OF interferes be cause for rejection, particularly If required by regulation. or may indicate (drowathess, diabetic come or Insulan any grehension or cower grasaing or (A) AC em tool, or leg the need for additional laboratory tests or more stringent examination sheck) which Interfeces wen the ability perform normal The administration of insure IS. attain keep. & perhaps by a medical specialist These decisions are usually made by the associated WITH operating commercial motor vehicle. or any complicates process requiring insule. rege, neede megical examined in light of the driver's job responsibilities work schedule Any other significant The serector amitation which interferes weeks security and state rechnique Factors related $5 and potential for the conditions to render the driver unsate with me scare to perform normal tasks PRESCRIES was eng-hauf commercial motor vehicle operations such a: Medical conditions should be recorded even If they are not cause for operating commercial monorvements or (iv) Mas DESR tatigue. as of SEED over de: emericans consitions, dental, and they should be discussed WITH the griver to encourage pranted Performance Evaluation OF Certificate stress. and concemitant line compound me mangers, persuant Baction 391.49 appropriate remedial care This advice is especially needes when a the FMCSA has consistent) neld mat disbetic who uses was suffers less food. No. hard or arm or condition If neglected. could develop into a serious line 65 that could affect - ter certify dees ne: mest the minimum physical whole Emb imparment any way interes *** the safe requirements of M FMCORS. driving performance of normal washs aspeciated with operating orage taken craly. Mr sometimes if the medical examiner determines that the driver is M to drive and is commercial metor a subject the ENE Performance prescribed for distatle individuals 10 neld stimulate nears also able to perform non-driving responsibilities as may be required the Evaluation Certification Program persuare to section body production of insults. " ve condition can be medical examiner signs the medical certificate which the chiver must carry 191 49. assumbing the person 10 otherwise completes by the use of ord medication and diet. ther an with his/her license. The certificate must be dated. Under current With the advancement rechnology. medical side and individualimay be qualified under the present CMV equipment modifications have been developed to compensate regulations, the certificate 18 valid for two years, unless the driver has drivers MRO do member the Federal diabetes standard for cenain disabilities. The SPE Certification Program a medical condition that does not pronibit driving out does require may call 356-1780 for 30 application for disbetes Homely the Lime Waiver Program) as designed to slow exemption. more requent monitoring in such situations, the medical certificate persons with the less foot or MR or with IDee Conference Report on Disbellc Discrders and should be Issued for # shorter length of lime. The physical examination impairment to quality under the Fegeral Motor Carder 3stety Commercials and mssim-Daing Commercial Motor should be done carefully and at reast as complete as is indicated by the Regulations (FMCSRM by ULE devices or Ventsis Drivers at: attached form. Contact the FMCSA at (202) for further equipment medifications which enable them to safety information (a vision exemption, qualifying drivers under 49 CPR 391.64, operate 4 commercial motor whise office there are nc medical Blds equivalents the original body DF smb certain note are etc.). Cardiavacouse Consition strt present, are thus restrictions may be includes cr individual SPE certificates when a State cter for the FMC BA determines $351 interpretation of Medical Standards person la physically qualified to drive a commercial they are recessary to be cons safety and public Since the Issuance the regulations for physical qualifications of motor wen toto If that person: Interest was no current ensical diagnosis of myocardial information. commercial drivers, the Federal Motor Carrier Safety Administration the driver 16 reund atterwise medicals qualified engine pectors, coronary insurficiency, meansoss OF any (FMCSA) has published recommendations called Advisory Criteria to help 1331 through (13), the medical examiner must check other conditions disease of pariety - to ts medical examiners in determining whether a driver meets the physical CR the medica certificate that the driver is qualified only # accompanced BY syncope costage or congestive qualifications for commercial driving These recommendations have been accompanced by IF certificate. The giver and the employing cardier Store. motor conter are subject to apprepriate service the criver concensed to provide information to medical examiners that (1)15 directly The term has no current cloice diagnosis of : operates motor which in imporate or fereign commerce relevant to the physical xamination and (2) 15 not already included in the specifically designed no encompass "# clinical cibgrests without current SPE certificate for his/her physical disability. medical examination form. The specific regulation 16 printed in itatics and of (1)# current condition, or (2) cardiovatcular condition WHICH DEL not Any stabilized 18 reference by section is highlighted. regardless of the time INC. THE term "Hrown to 22 76 on maximator of 2-3 sharmacologk agents accompanied by designed to rende $ dispensis (Bse Conference an Discrders 30me causes of secondary hypertension may DE ameriable to surgical of disease (1) which , accompanted by are Commercial Devers #1: symptoms of synceps. dyspnes, collapse or congestre intervention or specific pharmacelogic disease. cardiac fallung and/or (2) which likely to cause syncepe (Zee Cardiovascular Advisory Panel Guidelines for the Medical dycanes, collage = congestive cardier fature Hypertenation isamination of Commercial Moter Venibe Drivers at the ment of the FMCBRS to render unqualid a **** 41(b)(i) finces act devershe has a current disease % person physically qualified to diffe a commerce more accompanied by and/or mely 10 cause symptoms of vehicle that person: Rheum Arthribe Orthopests. Muscauser. syncese colapte. or congestive cardies fature. Has no corrent clinical disgnosis of high evate pressure male to interfere Mill operate a commercial mater Neuromuseular or Vasoular Disease ($91,41(b)(7) However. the subjective decision of shedier the nature and A cerson Is physically que to drive a coremercial mexor vehicle If severity of 50 Individual's condition will may cause ventre safety. systems of cardlovest for insufficiency is DE #7 Individual Hypertension alone Is unitsely B couse budden collable that person: base are qualification rests we the medical examiner and nowever, the Included increases when target organ Has 70 established medical history or cancel employees of theumatic the motor conter in those cases where Inere If on damage. earticularly cerebral vascular disease is present. arthritte muscuser. neuromiscular or vascular were occurrence of insufficiency (myscants This regulatory critere is based on FMCSA's interferes WEN me ability to control and arere # commercial motor information, thrombosis etc.) It suggested before driver Cerdievascular Advisory Guidenes for the Examination of 15 certified that he or ARE have rearng and stress DMV Drivers, which used the Dirth Repert of the Joint vericle samely electrocardiogram (ECG) no residual complications and no National Committee on Detection, Evaluation, and Certain sueases are known have state episodes of translerm physical imitations, and is taking no medication likely to Treatment of High Elece Pressure (1997). revecte weakness poor muscular coordination (stexts) sensions inserfere with safe driving Stage hypertension corresponds to systems BP C* sensetions (paresities) decreased mescure tone (hypotonis), visual Cerenary artery bypass surgery and pacemaker 140-153 mmHg and/or diastelle BP of 90-99 mm/g. The disturbances and pain which may be sudeenly Win implemiation are remedial procedures sad thus not driver with BP in this range a at DW for each recurring episode. these symptoms may become more unqualitying. Implantable cardiovarier are hypertension-related state and may be disausitions due to risk of syncebe Courseln is a medical certified to drive for one-year benod pressunced and remain Ref tonger perces of the Other diseases medical vestment which can Improve the health and safety Certification examinations should to cone annually have more instatous ansets and clealsy symptoms of muscle wasting of order and should nal, by was medically disquality thereofter and should be at less than 140/92 ess then (strophy), swelling and paresthesia which may not suddenly the commercial driver. The emphas should be CC the 163/100, certification may as extended one time for person but may restrict Namer movements and underlying medical condition(s - Require treatment and menths. eventually Imeriere wen ine solity 9 safely operate 3 metor vehicle 77 the general health drown. The FMODA should be blood pressure of 150-179 systems and or 133-109 contacted at (282) 356-17 for additional 11 considered Stage are the droer many instances these diseases are degenerative in name or may recommendations regarding the physical qualification of unquirited dering evaluation and result in delereration the received area. drivers on institution of meatment. The drover is given one time Once the individuals has been diagnosed at having a rheumadic, 13ee Cardiovasular Advisory Ponel Guidelines for the certification three months R to reduce his or her blood arthrest privapedic muscuise meuromuscular of vascular casese. Medical exemination of Commercial Mater Venicle Drivers pressure to than squal to 140/92. blued pressure sen hershe nas an established nistory of that dise asse The physician, the range is an absolute for drug therapy Provided treatment $ we telerated and the when examining an individual, should consider the fallowing: the Respiratory Dyclanation driver demonstrates EP value of 140/50 orless, he or she name and seventy at the reviewers condition isuch as sensory 1090 BSDT 41(b)(5) may be certified for ENG year from care of the exam. or loss of strength): (2) the degree of Initation present such as range person 5 physically qualited to are & commercial mebor The other certified annually increafter, of mation: (3) the inclinate propressive Imitation inot always encle Instperson: A blood pressure at or greater then 150 (systoic) and present interly but may mantfast itself over time) and (4) the Rethood Has no established medical history OF clinical signature of 110 considered Stage 3. nigh not for am state of sudden " severe functional impairment mests. the respiratory eyefunction Ikely to interfere *** ability to event. The oriver may not BE qualified, ever control and drive commercial motor vehicle sately. temperarily, unit reduced = 140/50 or less and treatment is artive **** not avail m cases where more frequent monthodog is Bree driver must be stem 32 31 ames. any change is Disolerated. The driver may DE certified for months and required . certificate for shorter period time may be issued. (See his or ner mental state 15 in direct conflict with highway standually severy 5 months) thereafter at rechack BP to Conterence DE Neuro'ogica Discroers and Commercial Drivers at: safety. Even the slightest moalment incespiratory Sunction 140.90 less. under emergency senditions (wher prester oxygen EMPLOY Annual recertification is recommended lime medical : recessary for performance) may be determental to safe examiner COME FIDT know the presently of hypertension prior driving. to treatment Teare are many conditions mat intestere with oxygen An elevated bloco pressure inding should be confirmed exchange sed may result in intellection including by subsequent measurem on different emphyseme chronic esthma, days chrenic bronchis and sleep aprios. Whe medical Treatment includes nonpharmacologic and examiner detects expiratory dystunction make any way pharmacologic receases as well 35 counseling to reduce " they 15 Intertere with the drrver's ability to service control other risk factors, Men ant/hyperten medications B/SD and artre a commental motor reside. the driver must be have side effects, the importance et which judged referred to a specialist for further evaluation and meraby. on an individual individuals means alemed to the Anticoeguation therapy for deep ven and/or hazares of mese medications while driving Gkhe effects of surrenary It not acqualitying ONCE commission or syncepe are particulary undestrable in contrum 0016 18 achieved. provided JONEY extremely venous commercial dilvers. examinations normal and the treading physician Secondary hypertension is based CO the above stager. gives favorable recommendation. Evaluation is warranted patient's peraistently hypertensive Epilepsy Montal Discrders Vision 8501 11(b)(10) A person ohysically qualified to drive commercial metor vehicle Aperson physicaly qualified 10 Grive 3 a meter person is physically awaited to shire . commercial meme iftrat serson wehicle than person: wehicle that person: Has RD exceptished medical history or citizen regnosis ******** Has 90 ments, nerveus organic or disease or Has distant scury of at least 20MB " each are or any other condition WRITE **** to cause loss of payments disorder skey to interfere mill: active to are # motor wes BY corrective lenses OF valuel scuty separately or any loss ef ability to control masor service. vericle corrected to 2040 or befter with sorrerive moses Enkepsy is chronic fonctions clease characterized by Emptions or adjustment prob ams contribute directly to an distant birecular scury of at cast 20:40 (Seelent " tre eyes seizures or epfindes that occur without warning resulting in 0.18 of individuals REVER memory. reasoning, attermon. and incoment. Mith or atthout corrective leases. Fate of usion of east TO valuntary CONTROL which may eac 2) less and/or THESE problems offer undente physical disconders, variety of degrees in the medicaler - each eye. and the active to seizures. Therefore, the following drivers cannot be qualified (1) Antional discreers 539 CAUSE drossiness, classess. receptize the colors of mails signats and assiss showing driver and has edicat history of splepsy: (2) driver who has * confustor, weakness OF staralysis that may seed standard red. green. and amber. current clinical disgnosis of entressy or (3) direct was 18 taking insperdination institution, loss of functional control and The serve ability to recognize the colors of is interpreted to medicator. susceptibility to accidents while driving Physical famgue. mean person can recognize and distinguish among wants an Individual has has sudden conuce of headache. impaired corcination recurring physical alments control signature are sevices snawing standard red. green and setzure * loss of consciousness of ansocun cause which did not and streets oath may te present such degree amber no cr she meets the minimum standard, EVER though ne require softse ture medication, the recision as 35 whener that that certification for commercia artiving is Instivisable Sometic or she may have some lybe of celor perception deficiency. if person's consion withliely cause loss of constitusness or of and psychosemate completed should be thoughty examined certain color perception tests are administered our 38 asity 23 control mator vehicle made on as individual back by ween determining an individual's overall reness to drive. heldhare, Yam) and doubtes tindings are the medical examiner ID consultation with T4 treatme physician. Discribers of perfodically intepactating nature. even in the discovered consoled test using signal RED preen and smber Before certification is considered, 11 $ suggested that month early stages at develsament may warrant alsows Mication may be employed = determine the ablie, torecognize wating period capse from the time of THE estsode. Poiswing the Many 305 and THEY orders have documented that "Mervous mess wanns sence LiS suppested that the Individual have complete trouble reimbed neursity personally or emotional or Consect lenses are REPRESENT If here to sufficient evidence neurological exambision. If the results arthe examplation are adjustment problems responsib for significant fraction at to assue 7591 the dirker has good interance and well negative and antisetzore medication is natrequired. then the driver their preventable accidents. The cegree to which an individual adapted to their use. Use contactions in one *** for may or qualified 15 able 15 appreciate. evaluate and adequately respond to chatance visus socialy and another REGIS 10 THE ciner ept formear in these Individual cases where a driver has a relaure or an environmental siran and emotoral stress is critical when wisten ($ not acceptable nor * rescopte lenses acceptable for episode of 1021 of conselous that resulted from shown assessing an registrate ments aiertness and destring to cope the driving of comments motor vehicles medical condition P.O. drug reaction high temperature, acute with the stresses of commercial most vehicle deving an Individual meets the criters of the use of d'esser or infectious disease, deliydration at artive metebolic disibrance). Vinen examining the order, " should be septin mine that certain the foreway statement shall appear on the certification securd be deferred unts the driver has fatty recovered individuals - TVE under chronts emptions upsets may have Medical Exambers Certificate "Qualified only If wearing from that consition 376 has no existing residual complications and deeply ingrained maindaptive expate paterns corrective tenses not taking andsetzure medication Excessively antageniste, instructive. importive. openty DMV crivers who 00 not meet the Federal vision standard Drivers with Alatory OFF aggressive parented OF severaly depressed behavior greaty mar (302) 365-1790 for 39 application for a vision medication and setzure 10 years may be qualified to drive interfere with the driver's ability drive safely These exemption. a DMV interstate commerce. Interstate drivers with history of individuals who are older susteption frequent states of (Bee visual Discreers and Commercial DENVERS at. a single procrasked setsure may be quality to drive CMV emotions examility (strizuphrents, attective interviate commerce selative free and all antisenture medication parancia analety = depressive neuroses: may for 5-year sense or more disqualification. Careful consideration should be given to the Hearing Des Conference on Neurcing Disorders and Commetcial side effects and interactions of medications THE 111 Drivers at: DUE iffication determination. are Psychianic Conference Report person 15 physically qual Thes to crive commercial netor STATE CCT governiesred for specific recommendations en the use medications and vericle TASH person: potential heards for driving. FAX perceives forced whistered voice in the better 207 at not (See Conference on Psychaine Disorders and Commercial uss man STreet with without me use or : hearing and or, Y Drivers at: tested by USE of an audioment device. noes nor here an hearing less - the netter preater Man at decess at SCO HZ 1.000 HE and 1,000 47 mith without hearing 250 when the device is calbrated to American National Standard stormers ADA Standard) 234 the the prescribed standard under the EMCARS 15 the American Standards Association CANGIL may be ceasary is consed the audicmetric results from the reo standard to the ANDI standard. instructors are Included on the Medical Exam nation rescritterm. an Individual meets The careria 97 using a hearng so The driver must wear that hearths and BRC have operater at: trues wate arting Also, the driver must be in association of spore DOWER service for the hearing ald For the whispered voice test. the individual should stationes " least feet from the examiner with the ear bets tested turned toward the examiner. The amer car 5 counted Using the treath REVER remains after normal The examiner shippers words of rendem sumbers such ** 65. 15. 77 23. ex The examine should not use only sistants ($ sounding materials. The about CBP mous be tested in the same manner if the falls the whopered voice test, the sustometic test should be administered an individual meals the cream by the USE of nesire 3/0 the folowing statement must sure: or the Medical Examiner's Certificate "Qualified only when wearng * hearing aid (See Hearing Discrders and Commercial Molor Vehicle Drivers at Drug Use $305,41(b)(12) Aperson is physically qualified to drive 3 commercial metor vehicle If that person Does met use a controlled substance a in 21 CFR 1308.11. Schedule an amonetamine, narzage, or any other habit-forming they Exception A driver may use SIZER substance or drug The substance or drug , cressribed by recessed megical practicner who is familier with the devers medical history and assigned dates: and has advised the deverther me prescriber substance or drug WE not affect me driver's ability to softy operate # commercial motor receive - exception 6001 not apply 10 memadone The intent of the medical contrication process a to medically events driver to ensure that the giver has no medical condition which interestes with the tate performance of driving tasks on public read. driver uses stredule arug or other substance. 30 emphalamine namest or any other habitterming drug. amay DE cause for the arter to be found medically enquired Motor carriers are encouraged to cbain prectioners written statement about the affects 20 transportation safety of the wie of particular drug. lesilTer controlled substances to notrecured as can of this plenntal certification process. The FMCSA or the driver's employer should be consented strectly for information on controlled substances and elcohol testing under Part 182 the FMCSRs. The 1898 "VIRS" is estaned to encompass instances of pronibited drug LEE determined By a physician a established medical means This may or may not Invoice body TWO testing. Moody fluid testing takes place positive test results should to confirmed by second test of greater specificity The term Mabil-forming IS intended 10 include any drap or medication generaty recognized SI capable of becoming habitus and which may impak the user's accury R operate 0 commercial motor vehicle safety The driver 15 medicaly uncusitied fee the duration of the pronisted drug)s) USE and are DECORD examination shows the stiver is trae from the prohibited druges) use Recersification may Invoice 5 submance souse assistion the SUCCESS(U) completion cis drug rehabilitation program, and 3 negative crug tear result Additionaly given that the certificate period 05 a two years. the examiner has the option to certify for seriod of less than 2 years this exampler determines more Arequent meakering 19 recuived. (See Conference CO Neurological Disorders and Commercial Drivers and Conference one Disorders and Commercial Drhers 32 him) Alcoholism $391 4116)(18) A person is physically auslified to crive summercial mater vehicle If that DETER Has no current emeal diagness of The term "Eurrent elinical dispnesis offis specifically designed R entompass current liness or those Instructs where the movievals physical condition nas not fully trabilized regardless of the time element 11 Individual shows signs having on sicohol-use problems. he or she should DE referred be . security After counseling and/or treatment. he or she may DD considered for certification (g) Si el médico examinador encuentra que la persona examinada está físicamente calificada para manejar un vehículo de motor de acuerdo con la Sección 391.41 (b), deberá completar un certificado en la forma prescrita en el inciso (h) de esta sección y proveer una copia a la persona examinada y otra al acarreador que lo emplea. (h) El siguiente certificado médico deberá ser completado en en tinta: MEDICAL EXAMINER'S CERTIFICATE certify that have examined in accordance with the Federal Motor Can rice Safety Regulations (49 CFR 301.41-391.48) and with knowledge of the driving And this person 9 qualified and I applicable. only when comertive I diving with an exampt intracity 2018 140 CFR 391.62) - and hearing and accompaned by a Skill Performance Evaluation Certificate (SPE) accoropanted by a waser exemption Qualified by operation of 49 CFR 391 64 The information have provided regarding this physical examination is true and complete. Acomplete examination form with any attachment embodes TTA fridings commetely and correctly and is on * in my once SIGNATURE OF MEDICAL EXAMINER TELEPHONE DATE MEDICAL EXAMINER/NAME (PRINT) Chiropracter MO DO Addressed Practice Physician Accestant Name MEDICAL EXMINER SUCENSE OR CERTIFICATE NO ESSLING STATE DAVER'S LICENSE NO STATE SIGNATURE OF DRIVER ADDRESS OF DRIVER MEDICAL CERTIFICATE EXPIRATION DATE 78