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Medical Examination Guidelines Summary

Medical Examination Report Form - Page 1

To print a sample Medical Examination Report form, select Medical Examination Form (PDF).

The first page of the Medical Examination Report form is for recording Driver Information and Health History. The driver completes these sections.

A complete physical examination is required for new certification and recertification. Verify that the date of the examination is accurate because this is used to calculate the expiration date.

Any individual can request and be given a Federal Motor Carrier Safety Administration physical examination. A person must be at least 21 years of age to operate a commercial motor vehicle (CMV) in interstate commerce. A person operating a CMV in interstate commerce must be medically examined, carry an original or copy of the medical examiner’s certificate while driving, and be currently licensed (commercial or noncommercial).

The health history is an essential part of the driver physical examination. Are there limitations resulting from a current or past medical condition? Are there symptoms that indicate additional testing or evaluation is needed? Discuss the safety implications of effects and/or side effects of prescription and over-the-counter medications, supplements, and herbs.

Ensure that the driver signs and dates the Medical Examination Report form. By signing the form, the driver certifies that the information and history are “complete and true.” The driver signature also acknowledges that providing inaccurate or false information or omitting information could invalidate the medical examiner’s certificate. A civil penalty may be levied under 49 U.S.C. 521(b)(2)(b) against the driver who provides a false or intentionally incomplete medical history. Everything above the driver signature should be completed by the driver.

As a medical examiner, you must clarify yes answers. Document the significant findings of the health history in the comments section below the signature of the driver.

Follow the links in the table for more information on health history specific to the topic.

Vision (b)(10)

Musculoskeletal (b)(1)(2)(7)

Hearing (b)(11)

Diabetes Mellitus (b)(3)

High Blood Pressure/Hypertension (b)(6)

Other Diseases (b)(9)

Psychological Disorders (b)(9)

Cardiovascular (b)(4)

Respiratory (b)(5)

Drug Abuse and Alcoholism (b)(12)(13)

Neurological (b)(7)(8)(9)

Medications/Drug Use (b)(12)

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