[Federal Register Volume 63, Number 150 (Wednesday, August 5, 1998)]
[Proposed Rules]
[Pages 41769-41781]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-20919]


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DEPARTMENT OF TRANSPORTATION

Federal Highway Administration

49 CFR Part 391

[FHWA Docket No. FHWA-98-3542]
RIN 2125-AC63


Physical Qualification of Drivers; Medical Examination; 
Certificate

AGENCY: Federal Highway Administration (FHWA), DOT.

ACTION: Notice of proposed rulemaking (NPRM); request for comments.

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SUMMARY: The FHWA is seeking comments on a proposal to amend its 
regulation governing the examination to determine the physical 
condition of drivers. The FHWA takes this action in response to 
numerous requests from medical examiners to update and simplify the 
medical examination form that is currently used. This proposed action 
is intended to reduce the incidence of errors on such forms and to 
provide more uniform medical examinations of commercial motor vehicle 
(CMV) drivers under the Federal Motor Carrier Safety Regulations 
(FMCSRs). The current Federal physical qualification standards tested 
by medical examiners and recorded on the form would not be revised in 
this rulemaking. The FHWA is seeking comments on the proposed form.

DATES: Written comments addressing this rule must be received on or 
before November 3, 1998.

ADDRESSES: Your signed, written comments must refer to the docket 
number appearing at the top of this document and you must submit the 
comments to the Docket Clerk, U.S. DOT Dockets, Room PL-401, 400 
Seventh Street, SW., Washington, D.C. 20590-0001. All comments received 
will be available for examination at the above address between 10 a.m. 
and 5 p.m., e.t., Monday through Friday, except Federal holidays. Those 
desiring notification of receipt of comments must include a self-
addressed, stamped envelope or postcard.

FOR FURTHER INFORMATION CONTACT: Mrs. Sandra Zywokarte, (202) 366-1790, 
Office of Motor Carrier Standards, for information regarding the 
rulemaking, or Ms. Judith A. Rutledge, (202) 366-0834, Motor Carrier 
Law Division, Office of the Chief Counsel, for information regarding 
legal issues. Federal Highway Administration, Department of 
Transportation, 400 Seventh Street, SW., Washington, D.C. 20590. Office 
hours are from 7:45 a.m. to 4:15 p.m., e.t., Monday through Friday, 
except Federal holidays.

SUPPLEMENTARY INFORMATION:

Electronic Access

    Internet users can access all comments received by the U.S. DOT 
Dockets, Room PL-401, by using the universal resource locator (URL): 
http://dms.dot.gov. It is available 24 hours each day, 365 days each 
year. Please follow the instructions online for more information and 
help.
    An electronic copy of this document may be downloaded using a modem 
and suitable communications software from the Federal Register 
Electronic Bulletin Board Service at (202)512-1661. Internet users may 
reach the Federal Register's home page at: http://www.nara.gov/nara/
fedreg and the Government Printing Office's database at: http://
www.access.gpo.gov/su__docs.

Background

    The authority to require medical certification of CMV driver 
qualification was originally granted to the Interstate Commerce 
Commission (ICC) in the Motor Carrier Act of 1935. The authority was 
transferred to the DOT in 1966 and is currently codified at 49 U.S.C. 
31502(b).
    The importance of physical qualification of commercial drivers was 
recognized in 1939 when the first regulatory medical standard was 
established by the ICC. Those

[[Page 41770]]

regulations, published June 7, 1939, required a driver to possess the 
following minimum qualifications:

    Good physical and mental health; good eyesight; adequate 
hearing; no addiction to narcotic drugs; and no excessive use of 
alcoholic beverages or liquors.

    The first change to this standard was initiated in 1952 and went 
into effect on January 1, 1954. The Certificate of Physical Evaluation 
required under the 1954 rule was slightly more specific than the 1939 
regulation, and also required a physical examination form and a 
doctor's certificate. A second revision made in 1964 amended the 
standard to allow limb-amputee and limb-impaired drivers, who were 
otherwise eligible, to become medically qualified through a waiver 
program. On April 22, 1970, (35 FR 6458) in light of discussions with 
the FHWA's medical advisors, the existing physical qualification 
requirements were substantially tightened by including guidelines for 
evaluation of persons in high-risk medical categories. This rule also 
provided that the examining physician be given full information about 
the responsibilities of and the exacting demands made on commercial 
drivers. There have been no major changes since then.

Current Medical Examination Form

    The current form was adopted by the DOT in 1970, recodified in 49 
CFR part 391, and has undergone no changes since that time. The 
physical qualification regulations for drivers in interstate commerce 
are found at 49 CFR 391.41. Section 391.43 contains instructions to 
medical examiners for performing physical examinations and recording 
their findings.
    The FHWA has received numerous verbal and written requests from 
physicians and other medical providers who perform physical 
examinations of CMV drivers engaged in interstate commerce to make 
changes to the medical form currently used under Sec. 391.43(e). 
Medical practitioners have indicated that the format, layout and 
content of the current form are outdated, difficult to use and contain 
irrelevancies. For example, the health history section of the form asks 
about a history of fits, syphilis and gonorrhea, and nervous stomach. 
Such inquiries reflect outdated terminology, are vague, or are not 
relative to a driver's ability to operate a CMV safely. Others have 
suggested that the form is not adaptable to current trends in 
documentation such as electronic documentation. Given these comments, 
the FHWA has decided to initiate this proposed rulemaking action.
    Over the past two decades there have been substantial changes in 
medical technology and the technology, operating practices and 
economics of the motor carrier industry. These changes have affected 
the lifestyles of and, therefore, the physical and mental demands 
placed on CMV drivers. The FHWA agrees that the current form is 
outdated and its continued use problematic.

Methods and Considerations for Developing a Revised Medical 
Examination Form

    The FHWA contracted with the Association for the Advancement of 
Automotive Medicine (AAAM) to review and evaluate the current form, and 
to help develop a revised form. In order to assure that the revised 
form would reflect the most current medical concepts and be responsive 
to the needs of the groups using the forms such as the medical 
community and the trucking industry, the AAAM convened a working group 
to review the draft form. This group included two occupational health 
physicians, a motor carrier and Federal and State government 
representatives. A second draft of the form was then submitted for 
additional review by a correspondence review group made up of medical 
providers, State agency representatives, motor carriers, FHWA field 
staff, and other interested groups.
    The form revision process was defined and limited by several norms. 
The underlying physical qualification standards tested by medical 
providers and recorded on the form would not be revised in this 
rulemaking. In addition, the instructions for performing and recording 
physical examinations found in 49 CFR 391.43 would be revised only to 
the extent necessary to ensure that instructions to medical examiners 
are understandable and consistent with the information provided on the 
proposed medical examination form and guidance materials established by 
the FHWA for medical examiners.

Proposed Medical Examination Form

    The proposed form, modeled on physical examination forms in use 
today, has been organized to gain simplicity and efficiency, to reflect 
current medical terminology and examination components and to be a 
self-contained document; that is, the proposed form will, to the extent 
possible, include all relevant information necessary to conduct the 
physical examination and certification. The FHWA believes its proposed 
revision to the form will enhance the accuracy and efficiency of the 
commercial driver physical qualification process.
    Consistent with accepted practices regarding the order of the 
examination, the first section of the proposed form would be completed 
by the driver. This section requests information on the driver's health 
history, seeking ``yes'' or ``no'' answers to a variety of medical 
condition questions. Any ``yes'' response would require further 
clarification by the driver. Once the form is completed, the driver 
would be required to sign it, affirming that all the information 
contained therein is accurate and complete. An additional statement 
indicates that inaccurate, false, or missing information may invalidate 
both the examination and any Medical Examiner's Certificate issued 
thereon. A result of such invalidation could include revocation of the 
driver's commercial license by the issuing State. The FHWA believes 
that the proposed addition of a driver certification requirement would 
discourage drivers from omitting or falsifying medical information and 
thereby would ensure the accuracy and completeness of the medical form 
and strengthen the overall certification process.
    The second section of the proposed form covers the physical 
examination and tests performed by the medical examiner. The medical 
examiner is provided with information on both the relevant Federal 
physical qualification standards and the tests required to measure 
compliance with those standards. The Federal standards and guidelines 
for evaluation of a driver's vision, hearing, and blood pressure are 
included in this section of the proposed form, thereby reducing the 
potential for errors by the medical examiner. Missing or inconsistent 
information on the examination form has been a problem according to 
anecdotal information provided by the motor carrier industry and other 
users of the form, and according to information obtained from six pilot 
demonstration programs to verify the six States' ability to merge the 
medical process with the CDL licensing process. 1
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    \1\ The pilot projects were completed in January 1995, and a 
final report (see docket, FHWA-97-2210) was submitted to the FHWA. 
On July 23, 1996, the FHWA announced (61 FR 38133) the first meeting 
of a negotiated rulemaking advisory committee under the Federal 
Advisory Committee Act and the Negotiated Rulemaking Act to consider 
the relevant issues and attempt to reach a consensus in developing 
regulations governing the proposed merger of the State-administered 
commercial driver's license procedures and the Federal driver 
physical qualification requirements. For complete information on the 
six pilot projects and the negotiated rulemaking advisory committee 
proceedings, see 59 FR 36338 (July 15,1994) and 61 FR 18713 (April 
29, 1996).

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    Unlike the current physical examination form, the proposed form 
clearly indicates when numerical readings must be recorded. Moreover, 
since the physical qualification regulations do not indicate acceptable 
laboratory values for the presence of protein, blood or sugar in the 
urine, the proposed form places the medical examiner on notice that the 
presence of these substances in the urine may be an indication for 
further testing to rule out an underlying medical condition that may be 
disqualifying. Space is also provided for optional tests, such as an 
electrocardiogram (ECG), an echocardiogram, an exercise stress test 
(EST) or a chest x-ray. In addition, a complete physical examination 
must be performed for each driver.
    Although the ECG and EST are considered optional, the FHWA is 
proposing specific recommendations for a baseline ECG at age 40, then 
every six years until age 55, and then every two years. In this 
proposal, the FHWA also recommends that an EST be given to asymptomatic 
individuals who are 45 years old or older and who either exhibit two or 
more cardiac risk factors or have a history of ischemic heart disease. 
These recommendations were developed during a 2-day conference on 
cardiac disorders and commercial drivers at the American College of 
Cardiology in Bethesda, Maryland in 1986. The conference was convened 
to assist the FHWA in developing a systematic and scientific basis for 
updating the cardiac standards for commercial drivers. The final report 
published in 1988 provided very specific recommendations for qualifying 
drivers with cardiovascular conditions and for screening drivers for 
cardiac risk factors. This cardiac conference guidance has been 
extensively peer reviewed and is being updated as necessary. A copy of 
this cardiac conference guidance is contained in the docket for public 
inspection.
    A full page of the proposed form is devoted to instruction and 
recordation of the medical examiner's findings. The medical certificate 
is also provided, and must be completed by the medical examiner if he 
or she finds that the driver meets all the Federal physical 
qualification requirements.
    The third section of the proposed form not only sets forth the 
Federal physical qualification standards found at 49 CFR 391.41, but 
also contains more detailed information for the medical examiner 
regarding the driver's role and the types of duties he or she may face 
as a result of his or her employment. The FHWA believes that this 
information is valuable to the medical examiner in making a 
determination of physical qualification, and that such information may 
not have been provided to medical examiners in the past because it was 
not included on the current medical examination form. This section also 
contains the FHWA's guidelines to help medical examiners assess a 
driver's physical qualification. These guidelines are strictly advisory 
and were established by the FHWA after consultation with physicians, 
States, and industry representatives.
    In addition to the revisions to 49 CFR 391.43 proposed in this 
NPRM, the FHWA is making technical corrections to paragraphs (d) and 
(g) of that section.
    The FHWA's primary concern is to enhance safety on the Nation's 
highways, not to unnecessarily limit the employment opportunities of 
individuals with physical impairments. To the fullest extent possible, 
consistent with its safety mandate and regulations, the FHWA is 
interested in promoting individual determinations of medical 
qualification to operate a CMV. The intent of this proposal is to 
facilitate medical providers' efforts to establish, and document in a 
clear and understandable way, the physical qualification of a driver to 
operate a CMV.
    Consequently, the FHWA requests comments from individuals, medical 
providers, motor carriers, and all other interested parties on the 
proposed medical examination form. The information should include, but 
need not be limited to, information on how to improve the proposed 
examination form and instructions for performing and recording physical 
examinations.

Rulemaking Analyses and Notices

    All comments received before the close of business on the comment 
closing date indicated above will be considered and will be available 
for examination in the docket room at the above address. Comments 
received after the comment closing date will be filed in the docket and 
will be considered to the extent practicable, but the FHWA may issue a 
final rule at any time after the close of the comment period. In 
addition to the late comments, the FHWA will also continue to file in 
the docket relevant information that becomes available after the 
comment closing date, and interested persons should continue to examine 
the docket for new material.

Executive Order 12866 (Regulatory Planning and Review) and DOT 
Regulatory Policies and Procedures

    The FHWA has determined that the proposed action, if implemented, 
would not be a significant regulatory action under Executive Order 
12866 or significant under the regulatory policies and procedures of 
the DOT. It is anticipated that the economic impact of this proposed 
rule would be minimal because the use of existing printed supplies of 
the forms addressed in this action will be allowed until the forms are 
depleted, or until 12 months after the date of publication of this 
rulemaking in the Federal Register, whichever occurs first. Allowing 
the use of existing forms would avert substantial monetary loss by 
motor carriers, medical providers, and vendors of forms that might 
otherwise result from this rulemaking. Moreover, the proposed action 
would facilitate regulatory uniformity and result in easier compliance 
with and enforcement of the driver qualification requirements of the 
FMCSRs. The proposed form would, to the extent possible, include all 
relevant information necessary to establish and record the physical 
qualification of a driver to operate a CMV. As a result, the FHWA 
believes that this rulemaking would have a positive economic impact. 
That is, time and cost burdens on truck and bus companies would not 
increase and, indeed, such burdens on medical examiners could actually 
decrease. Therefore, a full regulatory evaluation is not required.

Regulatory Flexibility Act

    In compliance with the Regulatory Flexibility Act, 5 U.S.C. 601-
612, the FHWA is evaluating the effects of this proposal on small 
entities. The FHWA believes that this proposed action, if implemented, 
would not have a significant economic impact on a substantial number of 
small entities or the nation's economy because it would allow 
individual small carriers, medical providers and vendors of the form to 
use the forms they now have on hand until those supplies have been 
depleted, or until 12 months after the date of publication of this 
rulemaking in the Federal Register. To the extent that the proposed 
revised form would facilitate compliance with driver qualification 
requirements, the projected positive economic impact is not expected to 
be sufficiently significant to warrant a full regulatory evaluation. 
The FHWA intends to further evaluate the economic consequences of this 
proposal on small entities, however, in light of the

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comments received in response to this notice of proposed rulemaking.

Unfunded Mandates Reform Act of 1995

    The FHWA will analyze any proposed rule to determine whether it 
would result in the expenditure by State, local, and tribal 
governments, in the aggregate, or by the private sector, of $100 
million or more in any one year, as required by the Unfunded Mandates 
Reform Act of 1995 (2 U.S.C. 1532).

Executive Order 12612 (Federalism Assessment)

    This proposed rulemaking, if promulgated, would amend Part 391 of 
the FMCSRs (Title 49, Code of Federal Regulations) pertaining to the 
physical qualification and examination of drivers. This proposal has 
been analyzed in accordance with the principles and criteria contained 
in Executive Order 12612. Nothing in this proposal would preempt any 
State law or regulation. This proposal would not limit the policy 
making discretion of the States. Therefore, the FHWA has determined 
that this proposal does not have sufficient federalism implications to 
warrant the preparation of a separate Federalism Assessment.

Executive Order 12372 (Intergovernmental Review)

    Catalog of Federal Domestic Assistance Program Number 20.217, Motor 
Carrier Safety. The regulations implementing Executive Order 12372 
regarding intergovernmental consultation on Federal programs and 
activities do not apply to this program.

National Environmental Policy Act

    The agency has analyzed this action for the purposes of the 
National Environmental Policy Act of 1969, as amended (42 U.S.C. 4321 
et seq.), and has determined that this action will not have any effect 
on the quality of the environment.

Paperwork Reduction Act

    The information collection requirements that would be imposed as a 
result of this rulemaking are being submitted to the OMB for approval 
in accordance with the Paperwork Reduction Act of 1995, 44 U.S.C. 3501-
3520. This rulemaking proposes a revision of a form used to collect 
medical information about drivers of commercial motor vehicles (CMVs).
    Title: Medical Qualifications Requirements.
    Affected Public: Approximately 400,000 motor carriers and 500,000 
medical examiners.
    Abstract: Medical examiners are required to perform examinations of 
CMV drivers who operate in interstate commerce. The results must be 
recorded substantially in accordance with the instructions and the form 
found at 49 CFR 391.43. Medical examiners are also required to fill out 
a medical certificate upon completing an examination. The certificate 
affirms that the driver is medically qualified to drive a CMV in 
interstate commerce.
    Under 49 CFR 391.51 and 398.3, motor carriers are required to 
retain the medical examiner's certificate in the driver's qualification 
file for 3 years.
    Need: To ensure that only physically qualified CMV drivers operate 
in interstate commerce.
    Requested Time Period of Approval: The information collection for 
this item, OMB Control Number, 2125-0080, was last approved by OMB on 
September 2, 1997. It is valid through September 30, 2000.
    Estimated Annual Burden: Based on an estimate of 5,500,000 
interstate CMV drivers, the annual time burden upon medical examiners 
and motor carriers for examinations and recordkeeping would be 
approximately 412,500 hours. This is a decrease of 46,605 hours from 
the burden under the previous form.
    Comments are invited on any aspect of the proposed collection of 
information, including but not limited to: (1) The necessity and 
utility of the information collection for the proper performance of the 
functions of the FHWA; (2) the accuracy of the estimated burden; (3) 
ways to enhance the quality, utility, and clarity of the collected 
information; and (4) ways to minimize the collection burden without 
reducing the quality of the collected information.

Regulation Identification Number

    A regulation identification number (RIN) is assigned to each 
regulatory action listed in the Unified Agenda of Federal Regulations. 
The Regulatory Information Service Center publishes the Unified Agenda 
in April and October of each year. The RIN contained in the heading of 
this document can be used to cross reference this action with the 
Unified Agenda.

List of Subjects in 49 CFR Part 391

    Driver qualifications--physical examinations, Highway safety, Motor 
carriers, Reporting and recordkeeping requirements, Safety, 
Transportation.

    Issued: July 29, 1998.
Kenneth R. Wykle,
Federal Highway Administrator.
    In consideration of the foregoing, the FHWA proposes to amend title 
49, CFR, chapter III, part 391 as follows:

PART 391--QUALIFICATIONS OF DRIVERS [REVISED]

    1. The authority citation for part 391 continues to read as 
follows:

    Authority: 49 U.S.C. 504, 31133, 31136, and 31502; and 49 CFR 
1.48.

    2. Section 391.43 is amended in paragraphs (d), (f), (g), and (h), 
to read as follows:


Sec. 391.43  Medical examination; certificate of physical 
qualification.

* * * * *
    (d) Any driver authorized to operate a commercial motor vehicle 
within an exempt intracity zone pursuant to Sec. 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) * * *
    (f) The medical examination shall be performed, and its results 
shall be recorded, substantially in accordance with the following 
instructions and examination form. Existing forms may be used until 
current printed supplies are depleted or until (Insert date 12 months 
after the date of publication in the Federal Register), whichever 
occurs first.

INSTRUCTIONS FOR PERFORMING AND RECORDING PHYSICAL EXAMINATIONS

    The medical examiner must be familiar with 49 CFR 391.41, 
Physical qualifications for drivers, and should review these 
instructions before performing the physical examination. Answer each 
question ``yes'' or ``no'' and record numerical readings where 
indicated on the physical examination form.
    The medical examiner must be aware of the rigorous physical, 
mental, and emotional demands placed on the driver of a commercial 
motor vehicle. In the interest of public safety, the medical 
examiner is required to certify that the driver does not have any 
physical, mental, or organic condition that might affect the 
driver's ability to operate a commercial motor vehicle safely.
    General information. The purpose of this history and physical 
examination is to detect the presence of physical, mental, or 
organic conditions of such a character 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. 
History of certain conditions 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 
their character or degree, indicate that certification of physical 
fitness should be denied. However, these conditions should be 
discussed with the driver and he/she should be advised to take the 
necessary

[[Page 41773]]

steps to insure correction, particularly of those conditions which, 
if neglected, might affect the driver's ability to drive safely.
    General appearance and development. Note marked overweight. Note 
any postural defect, perceptible limp, tremor, or other conditions 
that might be caused by alcoholism, thyroid intoxication or other 
illnesses.
    Head-eyes. When other than the Snellen chart is used, the 
results of such test must be expressed in values comparable to the 
standard Snellen test. If the driver wears corrective lenses for 
driving, these should be worn while driver's visual acuity is being 
tested. If appropriate, indicate the driver's need to wear 
corrective lenses to meet the vision standard on the Medical 
Examiner's Certificate 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 the smallest type read at 20 feet as the denominator. 
Monocular drivers are not qualified to operate commercial motor 
vehicles in interstate commerce. The use of contact lenses should be 
noted on the form and there should be sufficient evidence of good 
tolerance of and adaptation to their use.
    Ears. Note evidence of any ear disease, symptoms of aural 
vertigo, or Meuniere's Syndrome. When recording hearing, record 
distance from patient at which a forced whispered voice can first be 
heard. For the whispered voice test, the individual should be 
stationed at least 5 feet from the examiner with the ear being 
tested turned toward the examiner. The other ear is covered. Using 
the breath which remains after a normal expiration, the examiner 
whispers words or random numbers such as 66, 18, 23, etc. The 
examiner should not use only sibilants (s-sounding test materials). 
The opposite ear should be tested in the same manner. If the 
individual fails the whispered voice test, the audiometric test 
should be administered. For the audiometric test, record decibel 
loss at 500 Hz, 1,000 Hz, and 2,000 Hz. Average the decibel loss at 
500 Hz, 1,000 Hz and 2,000 Hz and record as described on the form. 
If the individual fails the audiometric test and the whispered voice 
test has not been administered, the whispered voice test should be 
performed to determine if the standard applicable to that test can 
be met.
    Throat. Note any irremediable deformities likely to interfere 
with breathing or swallowing.
    Heart. Note murmurs and arrhythmias, and any history of an 
enlarged heart, congestive heart failure, or cardiovascular disease 
that is accompanied by syncope, dyspnea, or collapse. Indicate onset 
date, diagnosis, medication, and any current limitation. An 
electrocardiogram (ECG), exercise stress test (EST) and other tests 
are required when findings so indicate. It is recommended that a 
baseline ECG be done at age 40, then every 6 years until age 55, 
then every 2 years thereafter, and an EST be done at age 45 if the 
individual manifests one or more cardiac risk factors or has a 
history of ischemic heart disease.
    Blood pressure(BP). If a driver has hypertension and/or is being 
medicated for hypertension, he or she should be recertified more 
frequently. An individual diagnosed with mild hypertension (initial 
BP is greater than 160/90 but below 181/105) should be certified for 
one 3-month period and should be recertified on an annual basis 
thereafter if his or her BP is reduced. An individual diagnosed with 
moderate to severe hypertension (initial BP is greater than 180/104) 
should not be certified until the BP has been reduced to the mild 
range (below 181/105). At that time, a 3-month certification can be 
issued. Once the driver has reduced his or her BP to below 161/91, 
he or she should be recertified every 6 months thereafter.
    Lungs. Note abnormal chest wall expansion, respiratory rate, 
breath sounds including wheezes or alveolar rales, impaired 
respiratory function, dyspnea, or cyanosis. Abnormal finds on 
physical exam may require further testing such as pulmonary tests 
and/or x-ray of chest.
    Abdomen and Viscera. Note enlarged liver, enlarged spleen, 
abnormal masses, bruits, hernia, and significant abdominal wall 
muscle weakness and tenderness. If the diagnosis suggests that the 
condition might interfere with the control and safe operation of a 
commercial motor vehicle, further testing and evaluation is 
required.
    Genital-urinary and rectal examination. A urinalysis is 
required. Protein, blood or sugar in the urine may be an indication 
for further testing to rule out any underlying medical problems. 
Note hernias or severe hemorrhoids. A condition causing discomfort 
should be evaluated to determine the extent to which the condition 
might interfere with the control and safe operation of a commercial 
motor vehicle.
    Neurological. Note impaired equilibrium, coordination, or speech 
pattern; paresthesia; asymmetric deep tendon reflexes; sensory or 
positional abnormalities; abnormal patellar and Babinski's reflexes; 
ataxia. Abnormal neurological responses may be an indication for 
further testing to rule out an underlying medical condition. Any 
neurological condition should be evaluated for the nature and 
severity of the condition, the degree of limitation present, the 
likelihood of progressive limitation, and the potential for sudden 
incapacitation. In instances where the medical examiner has 
determined that more frequent monitoring of a condition is 
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 to maintain steering wheel grip and to control 
other vehicle equipment during routine and emergency driving 
operations. If a foot or leg deformity exists, determine whether 
sufficient mobility and strength exist to enable the driver to 
operate pedals properly. In the case of any loss or impairment to an 
extremity which may interfere with the driver's ability to operate a 
commercial motor vehicle safely, the medical examiner should state 
on the medical certificate ``medically unqualified unless 
accompanied by a limb waiver.'' The driver must then apply to the 
Regional Director of Motor Carriers, in the region in which the 
driver has legal residence, for a limb waiver under Sec. 391.49.
    Laboratory and Other Testing. Other test(s) may be indicated 
based upon the medical history or findings of the physical 
examination.
    Diabetes. If insulin is necessary to control a diabetic driver's 
condition, the driver is not qualified to operate a commercial motor 
vehicle in interstate commerce. If mild diabetes is present and it 
is controlled by use of an oral hypoglycemic drug and/or diet and 
exercise, it should not be considered disqualifying. However, the 
driver must remain under adequate medical supervision.
    Upon completion of the examination, the medical examiner must date 
and sign the form, provide his/her full name, office address and 
telephone number. The completed medical examination form shall be 
retained on file at the office of the medical examiner.

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    (g) If the medical examiner finds that the person he/she examined 
is physically qualified to drive a commercial motor vehicle in 
accordance with Sec. 391.41(b), the medical examiner shall complete a 
certificate in the form prescribed in paragraph (h) of this section and 
furnish one copy to the person who was examined and one copy to the 
motor carrier that employs him/her.
    (h) The medical examiner's certificate shall be substantially in 
accordance with the following form. Existing forms may be used until 
current printed supplies are depleted or until (insert date 12 months 
after the date of publication in the Federal Register), whichever 
occurs first.

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[FR Doc. 98-20919 Filed 8-4-98; 8:45 am]
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