General Purpose of Health History and Physical Examination
The general purpose of the history and physical examination is to detect the presence
of physical, mental, or organic conditions of such character and extent as to affect
the driver ability to operate a CMV safely. This examination is for public safety
determination and is considered by FMCSA to be a “medical fitness for duty"
As a medical examiner, your fundamental obligation during the assessment of a driver
with diabetes mellitus who uses insulin is to establish whether the driver meets
all medical standards and guidelines in accordance with 49 CFR 391.41(b)(1-13),
other than the use of insulin to treat diabetes.
The examination is based on information provided by the driver (minimum 5-year history),
objective data (physical examination), and additional testing requested by the medical
examiner. Your assessment should reflect physical, psychological, and environmental
Medical certification depends on a comprehensive medical assessment of overall health
and informed medical judgment about the impact of single or multiple conditions
on the whole person.
Key Points for Examination When the Driver Has Diabetes Mellitus and Uses Insulin
This physical examination starts the Federal Diabetes Exemption Program application
process. The medical examiner evaluation
guidelines stipulate that the medical examiner review the 5-year medical
history of the driver. The driver must provide a 5-year medical history for your
review before you determine certification status.
The FMCSA Medical Examination Report form includes health history questions and
physical examination checklists. Additional questions should be asked to supplement
information requested on the form. You should ask about and document diabetes mellitus
symptoms, blood glucose monitoring, insulin treatment, and history of hypoglycemic
It is your responsibility to determine if the driver meets all medical standards
and guidelines, other than diabetes, in accordance with 49 CFR 391.41(b)(1-13).
Any other medical problems or conditions that prevent a driver being certified by
the medical examiner must be corrected BEFORE the driver submits an application
to the Federal Diabetes Exemption Program.
— You must review and discuss with the driver any "yes" answers
Does the driver have diabetes mellitus or elevated blood glucose controlled by:
Recommendations — Questions that you may ask include:
Does the driver:
- Newly started on insulin have documentation of completion of minimum
- With a valid Federal diabetes exemption have documentation of compliance
with program requirements for specialist evaluation?
- Routinely monitor blood glucose level and have device record for review?
- Use over-the-counter medications and/or supplements?
- Use an incretin
- Have a history of fainting, dizziness, or loss of consciousness?
- Have a history of hypoglycemic reactions that resulted in:
- Loss of consciousness?
- Need of assistance from another person?
- Period of impaired cognitive function that occurred without warning?
- Carry rescue glucose while driving?
NOTE: When the driver has a positive history for severe hypoglycemic
reactions, ask about occurrences, including if the driver had:
- One or more occurrences within last 12 months?
- Two or more occurrences within last 5 years?
— You must evaluate
On examination, does the driver have:
- Glycosuria (dip stick urinalysis)?
- Signs of target organ damage associated with dysfunction of the senses,
- Signs of target organ damage that can cause gradual or sudden incapacitation,
State-issued Medical Waivers and Exemptions
It is important that as a medical examiner you distinguish between intrastate waivers/exemptions
and Federal diabetes exemptions for insulin-treated diabetes mellitus.
— You must document discussion with the driver about:
- Any affirmative history, including if available:
- Onset date, diagnosis.
- Medication(s), dose, and frequency.
- Any current limitation(s).
- Potential negative effects of medication use, including over-the-counter
medications, while driving.
- Any abnormal finding(s), noting:
- Effect on driver ability to operate a CMV safely.
- Advice to take the necessary steps to correct the condition as soon
as possible particularly if the condition, if neglected, could result in more serious
illness that might affect driving.
- Any additional medical tests and evaluation.
When documenting the certification of the driver with diabetes mellitus who uses
insulin, ensure that the Medical Examination Report form periodic monitoring interval
and the Medical Examiner's Certificate expiration date agree and do not exceed 1
year. When the driver has or must obtain a Federal diabetes exemption:
- Mark the "accompanied by a ______________" exemption checkbox.
- Write "Federal diabetes" on the line.
- Circle "exemption."
In the case of the driver who has documentation of having been a participant in
good standing in the Federal diabetes study on March 31, 1996, mark the "Qualified
by operation of 49 CFR 391.64" checkbox.
NOTE: Proof of grandfathered status is the original letter from
1996 granting the right to continue to drive as long as the driver can meet physical
qualification requirements. If a letter is not provided, you may verify driver participation
in the study program—and the driver can obtain a new copy of the letter—by
calling the FMCSA Exemption Program Office at 703-448-3094.
The diabetes qualification standard parameter is use of insulin, not the diagnosis
of diabetes mellitus.