Medical Examination Guidelines

Question 1

The purpose of the physical examination is to …

Answer 1

… detect the presence of any physical, mental, or organic conditions or such character and extent as to affect the ability of the driver to operate a CMV safely.

Question 2

As a medical examiner, your fundamental obligation is to establish…

Answer 2

…whether a driver has a disease, disorder, or injury resulting in a higher than acceptable likelihood for gradual or sudden incapacitation or sudden death, thus endangering public safety.

Question 3

Who completes the health history section of the Medical Examination Report Form?

Answer 3

The Driver completes and adds additional info for any yes responses, but the Medical Examiner reviews and adds comments.

Question 4

When can you use a Skilled Performance Evaluation (SPE)?

Answer 4

They are designed for FIXED deficits of the extremities and cannot be used for deficits caused by progressive disorders.

Question 5

At a minimum, your comments on the health history section of the medical examination report form should include…

Answer 5

Nature of a positive history and the effect on driving ability

Discussion about medication and/or treatment effects and side effects that might interfere with driving ability

Question 6

What are the federal vision standards?

Answer 6

Distant visual acutiy of at least 20/40 (Snellen) in each eye, with or without corrective lenses

Distant binocular visual acuity of at least 20/40 (Snellen) in both eyes, with or without corrective lenses

Field of vision of at least 70 degrees in the horizontal meridian in each eye

Ability to recognize and distinguish among the colors of traffic signals and devices showing the standard red, amber, and green.

Question 7

What is used to test visual acuity?

Answer 7

Snellen chart, or other test that gives results in Snellen-comparable values.

Question 8

T or F:

Vision is the only portion of the driver physical examination that can be performed and certified by a provider other than a medical examiner

Answer 8

True

Vision testing and certification may be completed by an ophthalmologist or optometrist in necessary to obtain adequate evaluation of vision with specialized diagnostic equipment.

Must attach specialist report

Question 9

What are the federal hearing standards?

Answer 9

First perceive a forced, whispered voice in one ear at not less than five feet
OR
Not have an average hearing loss in one ear greater than 4 dB at 500Hz, 1000Hz, and 2000Hz

Test in both ears but only one ear needed to pass.

Only one test needed to pass. If they pass the first test, no need to do the second.

Question 10

May a driver use a hearing aid to meet the hearing standard?

Answer 10

Yes

If so, they must use a hearing aid while driving

Question 11

How must BP be measured?

Answer 11

Only readings taken during the exam or follow up will count

BP > 139/89 must be confirmed with a second measurement taken later during the examination

Record additional BP measurement in your comments on the Medical Examination Report form

Question 12

A one-time, three-month medical certificate is granted in what two cases involving BP?

Answer 12

If driver has a BP that is equivalent to Stage 2 HTN (160-179/100-109)

A driver that was certified with Stage 1 HTN who has not achieved a BP less than or equal to 140/90 at recertification.

Question 13

For a BP reading that has values where the individual systolic and diastolic readings are in different stages, you should…

Answer 13

Classify the reading by the higher stage

Question 14

If driver’s BP is <140/90, how long til recertification?

Answer 14

2 years if otherwise qualified

Question 15

If driver’s BP is Stage 1 HTN (140-159/90-99), how long til recertification

Answer 15

1 year from date of exam

Question 16

If driver’s BP is Stage 2 HTN (160-179/100-109), how should you certify?

Answer 16

One-time certificate for 3 months, then 1 year from date of original exam if less than 140-90

Question 17

If driver’s BP is Stage 3 HTN (>180/110), should you certify?

Answer 17

You should disqualify

A driver with Stage 3 hypertension (greater than or equal to 180/110) is at an unacceptable risk for an acute hypertensive event

Question 18

If a driver is disqualified based on Stage 3 HTN, when can you reconsider him for certification?

Answer 18

Following effective treatment for HTN evidenced by BP stabilized at >/= 140-90

6-mo expiration and recertification dates apply and patient must tolerate meds with no side effects affecting operation of a CMV

Question 19

What parts of the UA are required to be tested?

Answer 19

Specific Gravity
Protein
Blood
Glucose

Question 20

Is there a min/max weight/height regulation?

Answer 20

No, but you should consider height and weight factors as part of the overall driver medical fitness

Question 21

What should you do if there is an abnormal finding on exam that is not disqualifying?

Answer 21

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

Question 22

For any abnormalities on PE, what do you need to document?

Answer 22

Start comments with the number for the body system (ie 2 for eyes)

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

Question 23

What body systems are part of the physical exam?

Answer 23

General appearance
Eyes
Ears
Mouth/throat
Heart
Lungs and Chest (not incl breast)
Abdomen and Viscera
Vascular System
Genitourinary System
Extremities
Spine/other musculoskeletal
Neurological

Question 24

When can a driver be referred to the SPE program?

Answer 24

If you find a driver is medically qualified except for a fixed deficit on an extremity caused by the loss or functional impairment of a limb, you can qualify the driver subject to obtaining an SPE certificate

Question 25

When certifying a driver, discussion may include…

Answer 25

Reason for periodic monitoring and shortened exam interval if appropriate

Additional requirements associated with certification

Medical Examiner’s Certificate expiration info (occurs at midnight on the expiration date, has no grace period)

Question 26

When disqualifying a driver, discussion may include…

Answer 26

Reason for disqualification

Steps that can be taken to meet certification standards

Temporary disqualification (reason, length of waiting period, conditions that could restart the waiting period, documentation required)

Question 27

How long must you retain the Medical Examination Report Form and Medical Examiner’s Certificate?

Answer 27

Minimum of 3 years

Question 28

When should a driver receive a copy of the medical examination report form?

Answer 28

If applying for or renewing an SPE certificate, Diabetes exemption certificate, or Vision exemption certificate.

Question 29

Where does the Medical Examiner’s Certificate go?

Answer 29

Provide the original to the driver

Retain a copy for a min of 3 years

You may provide a copy to the prospective or current employer upon request (driver must sign a release)

Question 30

What does the driver need to do with the medical certificate?

Answer 30

Driver must carry the medical examiner’s certificate while operating a CMV.

The certificate can be the original, a copy of the original, or a reduce-size copy of the original.

Question 31

Who is the Diabetes Exemption Program for?

Answer 31

Allows some drivers with DM who use insulin replacement therapy to drive a a CMV

Question 32

Who is the Vision Exemption Program for?

Answer 32

Allows some drivers with monocular vision to drive a CMV