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Medical Examination Report Form

Physical Examination

Medical Examiner Completes

Physical Examination — Record Driver Height and Weight

  Regulations — You must measure and record driver height (inches) and weight (pounds)

The physical qualification standards do not include any maximum or minimum height and weight requirements. You should consider height and weight factors as part of the overall driver medical fitness for duty.

NOTE: Trained assistive personnel may measure height and weight. However, the Medical Examiner must sign the Medical Examination Report form. By signing the Medical Examination Report form, you are taking responsibility for and attesting to the validity of all documented test results.

Physical Examination — Medical Examiner Responsibilities

The general purpose of the 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 commercial motor vehicle (CMV) safely. This examination is for public safety determination and is considered by the Federal Motor Carrier Safety Administration (FMCSA) to be a "medical fitness for duty" examination.

  Regulations — You must perform the described physical examination

The physical examination should be conducted carefully and must, at a minimum, be as thorough as the examination of body systems outlined in the Medical Examination Report form. For each body system, mark "Yes" if abnormalities are detected, or "No" if the body system is normal.

You must document abnormal findings on the Medical Examination Report form, even if not disqualifying.

Start your comments using the number to indicate the body system (e.g., 2 for eyes or 8 for vascular system). Your comments should:

  • Indicate whether or not the abnormality affects driving ability.
  • Indicate if additional evaluation is needed to determine medical fitness for duty.
  • Include a copy of any supplementary medical evaluation obtained to adequately assess driver health.
  • Document your discussion with the driver, which may include advice to seek additional evaluation of a condition that is not disqualifying but could, if neglected, worsen and affect driving ability.
  • Indicate whether or not the body has compensated for an organic disease adequately to meet physical qualification requirements.
 Body System (Column 1) — CHECK FOR: Overview

1. General Appearance

Observe and note on the Medical Examination Report form any abnormalities with posture, limps, or tremors. Also observe and note driver affect and overall appearance. Note driver demeanor and whether responses to questions indicate potential adverse impact on safe driving.

Is the driver markedly overweight? If yes, what are the clinical and safety implications when integrated with all other findings?

Are there signs of current alcohol or drug abuse? If yes, refer the driver to a specialist for evaluation. After successful counseling and/or treatment, a driver may be considered for certification, as long as no residual limitations exist that could interfere with the ability to safely operate a CMV.

2. Eyes

At a minimum, you must check for pupillary equality, reaction to light and accommodation, ocular motility, ocular muscle imbalance, extraocular movement, nystagmus, and exophthalmos.

Does your examination find any abnormality that interferes with driving ability? Is an eye abnormality an indicator that additional evaluation, perhaps by a specialist, is needed to assess the nature and severity of the underlying condition?

NOTE: Special diagnostic equipment may be needed to adequately assess a driver with a known diagnosis or who is at risk for retinopathy, cataracts, aphakia, glaucoma or macular degeneration. Referral to a vision specialist may be required.

3. Ears

You should check for evidence of any aural disease or condition. At a minimum, you must check for scarring of the tympanic membrane, occlusion of the external canal, and perforated eardrums.

Does your examination of the ear find abnormalities that might account for hearing loss or a disturbance in balance? Should the driver consult with a primary care provider or hearing specialist for possible treatment that might improve hearing test results?

The presence of some hearing disorders, such as Meniere's disease, may interfere significantly with driving ability and the performance of other CMV driver tasks. In this case, guidelines recommend not to certify the driver.

4. Mouth and Throat

Does the condition or treatment require long-term follow-up and monitoring to ensure that the disease is stabilized, and the treatment is effective and well tolerated?

5. Heart

You must examine the heart for murmurs, extra sounds, enlargement, and a pacemaker or implantable cardioverter defibrillator. Check the lower extremities for pitting edema and other signs of cardiac disease.

Does your examination find any abnormalities that indicate the driver may have a current cardiovascular disease accompanied by and/or likely to cause symptoms of syncope, dyspnea, collapse, or congestive cardiac failure?

Can the condition be corrected surgically or managed well by pharmacological treatments? Is the disease progressive?

Does the condition or treatment require long-term follow-up and monitoring to ensure that the disease is stabilized and treatment is effective and well-tolerated?

NOTE: There are no work restrictions permitted. The commercial driver must be able to perform all job-related tasks, including lifting, to be certified.

6. Lungs and Chest, Not Including Breast Examination

You must examine the lungs and chest for abnormal chest wall expansion, respiratory rate, and breath sounds including wheezes or alveolar rales. You must check for impaired respiratory function and cyanosis. Be sure to examine the extremities to check for clubbing of the fingers and other signs of pulmonary disease.

Does your examination detect a respiratory dysfunction that in any way could interfere with the ability of the driver to safely operate a CMV? The driver may need to have additional pulmonary function tests and/or have a specialist evaluation to adequately assess respiratory function.

 Body System (Column 2) — CHECK FOR: Overview

7. Abdomen and Viscera

You must check for enlarged liver and spleen, masses, bruits, hernia, and significant abdominal wall muscle weakness. Check for tenderness and auscultate for bowel sounds.

Does an abnormal finding suggest a condition that might interfere with safe CMV operation? You should not make a certification decision until the etiology is confirmed, and treatment has been shown to be adequate/effective and safe.

8. Vascular System

You must check for abnormal pulse and amplitude, carotid or arterial bruits, and varicose veins. Check for pedal pulses.

The diagnosis of arterial disease should prompt you to evaluate for the presence of other cardiovascular diseases. Adequate evaluation may require additional testing and/or specialist examination.

9. Genitourinary System

You must check for hernias. You should evaluate any hernia that causes the driver discomfort to determine the extent to which the condition might interfere with the ability of the driver to operate a CMV safely. Obtain further testing and evaluation as required.

An abnormal urinalysis indicates further testing to rule out underlying medical problems.

NOTE: You cannot certify a driver who has not provided a urine specimen.

10. Extremities-Limb Impaired. Driver may be subject to Skill Performance Evaluation (SPE) certificate if otherwise qualified.

Check for fixed deficits of the extremities caused by loss, impairment, or deformity of an arm, hand, finger, leg, foot, or toe. Does the driver have a perceptible limp?

Does the driver have sufficient grasp and prehension in the upper limbs to maintain steering wheel grip? Does the driver have sufficient mobility and strength in lower limbs to operate pedals properly?

Does the driver have signs of progressive musculoskeletal conditions, such as atrophy, weakness, or hypotonia?

Does the driver have clubbing or edema that may indicate the presence of an underlying heart, lung, or vascular condition?

NOTE: If you find a driver is medically qualified EXCEPT FOR a fixed deficit of an extremity caused by the loss or functional impairment of a limb, you can qualify the driver, subject to obtaining an SPE certificate. The SPE program is intended only for individuals with fixed deficits of the extremities (not for individuals with progressive diseases).

11. Spine, Other Musculoskeletal

You must check the entire musculoskeletal system for previous surgery, deformities, limitations of motion, and tenderness. Does the driver have a diagnosis or signs of a condition known to be associated with acute episodes of transient muscle weakness, poor muscular coordination, abnormal sensations, decreased muscular tone, and/or pain? What is the:

  • Nature and severity of the condition?
  • Degree of limitation present?
  • Likelihood of progressive limitation?
  • Likelihood of gradual or sudden incapacitation?

12. Neurological

You must examine the driver for impaired equilibrium, coordination, and speech pattern. Does the driver have ataxia? Are deep tendon reflexes asymmetric? Are patellar reflexes normal? Is Babinski's reflex negative or normal? Are there any sensory or positional abnormalities?

Does an abnormal finding suggest a condition that might interfere with safe CMV operation? You should not make a certification decision until the etiology is confirmed, and treatment has been shown to be adequate/effective and safe.

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