Federal Motor Carrier Safety Administration (FMCSA) Medical Examiner Handbook Table of Contents Introduction .................................................................................................................................................. 7 Part I – The Federal Motor Carrier Safety Administration (FMCSA) ............................................................ 8 About the FMCSA .................................................................................................................................... 8 FMCSA Mission Statement .................................................................................................................. 8 About the Office of Medical Programs ..................................................................................................... 8 The Office of Medical Programs Mission Statement ............................................................................ 8 About the National Registry of Certified Medical Examiners ................................................................... 9 The National Registry of Certified Medical Examiners Mission Statement .......................................... 9 The Medical Examiner ......................................................................................................................... 9 Medical Certification ........................................................................................................................... 10 Privacy and the Medical Examination .................................................................................................... 10 Medical Examination Report Form ..................................................................................................... 10 Medical Examiner’s Certificate ........................................................................................................... 11 Medical Regulations Summary .............................................................................................................. 11 Code of Federal Regulations — LAW ................................................................................................ 11 Medical Standards/Advisory Criteria/Guidelines ................................................................................ 12 Medical Regulations Summary Table ................................................................................................ 12 Exemptions ........................................................................................................................................ 14 Important Definitions .............................................................................................................................. 14 Regulation Definitions ........................................................................................................................ 14 Part II - The Job of Commercial Driving ..................................................................................................... 16 FMCSA Regulates Interstate Commercial Operation ............................................................................ 16 Drivers ................................................................................................................................................ 16 Vehicles .............................................................................................................................................. 16 Truck and Bus Companies ................................................................................................................. 16 State Regulations ............................................................................................................................... 17 The Driver and the Job of Commercial Driving ...................................................................................... 17 The Driver .......................................................................................................................................... 17 The Job of Commercial Driving .......................................................................................................... 18 FMCSA Commercial Driving Facts and Research ................................................................................. 20 Office of Analysis, Research, and Technology .................................................................................. 20 Part III - Medical Examination Guidelines .................................................................................................. 23 About 49 CFR 391.43 ............................................................................................................................ 23 Purpose of Interstate Commercial Driver Physical Examination ........................................................ 23 Driver/Medical Examiner Relationship ................................................................................................... 23 Purpose of Physical Examination ....................................................................................................... 23 The Issue Is Risk ................................................................................................................................ 23 Consider Safety Implications .............................................................................................................. 24 Page 2 of 260 Medical Examiner Do's ...................................................................................................................... 24 Medical Examination Report Form - Overview ...................................................................................... 25 Driver Information ............................................................................................................................... 26 Health History ..................................................................................................................................... 27 Vision ................................................................................................................................................. 33 Hearing ............................................................................................................................................... 34 Blood Pressure/Pulse ......................................................................................................................... 36 Urinalysis ............................................................................................................................................ 38 Physical Examination ......................................................................................................................... 39 Determine Certification Status ........................................................................................................... 43 Certify ................................................................................................................................................. 44 Disqualify ............................................................................................................................................ 48 Issue Medical Examiner's Certificate ................................................................................................. 49 Part IV - Physical Qualification Standards and Advisory Criteria ............................................................... 51 Physical Qualification Standards (Regulations) versus Advisory Criteria (Medical Guidelines) ............ 51 Ongoing Standards and Guidelines Review Process ............................................................................ 51 About 49 CFR 391.41 ............................................................................................................................ 52 Vision ..................................................................................................................................................... 52 Vision Regulation 49 CFR 391.41(b)(10) ........................................................................................... 52 Health History and Physical Examination .......................................................................................... 53 Certification and Documentation ........................................................................................................ 56 Hearing................................................................................................................................................... 59 Hearing Regulation 49 CFR 391.41(b)(11) ........................................................................................ 60 Health History and Physical Examination .......................................................................................... 60 Certification and Documentation ........................................................................................................ 62 Advisory Criteria/Guidance ................................................................................................................ 63 Hypertension .......................................................................................................................................... 64 Blood Pressure (BP) Regulations 49 CFR 391.41(b)(6) and 49 CFR 391.43(f) ................................ 65 Health History and Physical Examination .......................................................................................... 65 Advisory Criteria/Guidance