[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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