Medical Examination Guidelines Flashcards
The purpose of the physical examination is to …
… 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.
As a medical examiner, your fundamental obligation is to establish…
…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.
Who completes the health history section of the Medical Examination Report Form?
The Driver completes and adds additional info for any yes responses, but the Medical Examiner reviews and adds comments.
When can you use a Skilled Performance Evaluation (SPE)?
They are designed for FIXED deficits of the extremities and cannot be used for deficits caused by progressive disorders.
At a minimum, your comments on the health history section of the medical examination report form should include…
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
What are the federal vision standards?
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.
What is used to test visual acuity?
Snellen chart, or other test that gives results in Snellen-comparable values.
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
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
What are the federal hearing standards?
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.
May a driver use a hearing aid to meet the hearing standard?
Yes
If so, they must use a hearing aid while driving
How must BP be measured?
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
A one-time, three-month medical certificate is granted in what two cases involving BP?
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.
For a BP reading that has values where the individual systolic and diastolic readings are in different stages, you should…
Classify the reading by the higher stage
If driver’s BP is <140/90, how long til recertification?
2 years if otherwise qualified
If driver’s BP is Stage 1 HTN (140-159/90-99), how long til recertification
1 year from date of exam
If driver’s BP is Stage 2 HTN (160-179/100-109), how should you certify?
One-time certificate for 3 months, then 1 year from date of original exam if less than 140-90
If driver’s BP is Stage 3 HTN (>180/110), should you certify?
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
If a driver is disqualified based on Stage 3 HTN, when can you reconsider him for certification?
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
What parts of the UA are required to be tested?
Specific Gravity
Protein
Blood
Glucose
Is there a min/max weight/height regulation?
No, but you should consider height and weight factors as part of the overall driver medical fitness
What should you do if there is an abnormal finding on exam that is not disqualifying?
You must document all abnormal findings on the Medical Examination Report Form, even if not disqualifying.
For any abnormalities on PE, what do you need to document?
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
What body systems are part of the physical exam?
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
When can a driver be referred to the SPE program?
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
When certifying a driver, discussion may include…
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)
When disqualifying a driver, discussion may include…
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)
How long must you retain the Medical Examination Report Form and Medical Examiner’s Certificate?
Minimum of 3 years
When should a driver receive a copy of the medical examination report form?
If applying for or renewing an SPE certificate, Diabetes exemption certificate, or Vision exemption certificate.
Where does the Medical Examiner’s Certificate go?
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)
What does the driver need to do with the medical certificate?
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.
Who is the Diabetes Exemption Program for?
Allows some drivers with DM who use insulin replacement therapy to drive a a CMV
Who is the Vision Exemption Program for?
Allows some drivers with monocular vision to drive a CMV
