Embed Size (px)
Citation preview
The Commercial Driver Medical Examiner
Course Overview
Module 1
EDUCATION
Save the date!
Download this Resource to view Table of Contents and enable bookmark feature.
The Commercial Driver Medical ExaminationDetermining the Medical Fitness of the Commercial DriverCourse Overview and Module 1 – OverviewUpdate 2016Natalie P. Hartenbaum, MD, MPH, FACOEM
President and Chief Medical OfficerOccuMedix, Inc.
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
This ME training course conforms to FMCSA’s training curriculum modules and topics on regulations and guidelines for conducting CMV driver medical examinations. FMCSA regulations and guidelines are reviewed regularly, and the training is March 2016
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Course Overview• Purpose
• Prepare participants for NRCME examination• Provide resources
• Regulations• Guidelines• Literature
• Decision points ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Course Material Format• Module X:
• Pre-read material – primarily derived from ME Handbook• Background, history, physical, treatment
• Course material• Presentation material (key review and
certification determination)
• Post-read material• Supplemental but essential for NRCME
examination
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Course Material Format• Supplemental resource material
• Expert Panel Recommendations• Medical Review Board
Recommendation• Other resources
•NOT FROM FMCSA -NOT for NRCME examination
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Important Issues• CME and MOC
• Category 1 – Didactic • Category 2• MOC – obtain booklet
• MUST vs May• Handbook vs Other Sources
• “official” vs other• All material in slides is from handbook unless
otherwise noted• CD Note – Course Director Note
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Reminder• Slides are from the FMCSA Medical Examiner Handbook
unless noted• Handbook is largely based on Conference reports from 1988-1991,
little has been updated – HANDBOOK DOWN FOR UPDATE
• Course goal to allow participants to meet the training requirements and pass the NRCME examination
• The only absolute medical standards are seizures, vision, insulin and hearing – although may be exemptions• Remainder is guidance
• FMCSA has stated examiners may use other sources of information for decision-making.
• Consider current best practices
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
FMCSA Sample Training - Sleep Disorders• Review current FMCSA recommendations for sleep disorders that have completed the public
notice and comment process, including:• Summarized in online Medical Examiner Handbook, Chronic Sleep Disorders.
• Identify sleep disorders as a condition under current review by FMCSA.• Note: It is important that the training clearly distinguishes between what constitutes current
FMCSA medical guidance and recommendations by advisory panels, boards, and other stakeholders as to what FMCSA guidance should be
• Remember that Medical Examiner Certification Test items use current guidelines, but medical examiners may choose to use best practices or other guidelines.
• Documentation should highlight the differences between the guideline used and the current guideline, as well as the rationale for the choice made.
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Recall Questions• At end of each module• Will review if time permits
• If not review prior to taking examination
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
What Do I Do After the Course?1. Post-Reading Materials
• Complete the post-reading materials found on your CD or via the secure page on the ACOEM website
2. Proof of Participation• Submit the Proof of Participation Request form to ACOEM confirming
your completion of the post-reading. ACOEM will mail you a certificate.
3. NRCME Examination• NRCME Website: https://nationalregistry.fmcsa.dot.gov• If you haven’t already done so, create your NRCME Account. This will
give you your ‘Registry Number.’ • Once your account is created, locate a testing center near you and
register for the NRCME Examination.
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Hartenbaum’s Rule on Commercial Driver’s Medical Evaluation
With the exception of the absolute regulated criteria,
There is often no absolute answer for a given
diagnosis,
Applicable to all drivers with that diagnosis
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
NRCMECore Curriculum Specifications(1) Background, rationale, mission and goals of the FMCSA medical examiner s role in reducing crashes, injuries and fatalities involving commercial motor vehicles
(2) Familiarization with the responsibilities and work environment of commercial motor vehicle (CMV) operations
(3) Identification of the driver and obtaining, reviewing, and documenting driver medical history, including prescription and over-the-counter medications
(4) Performing, reviewing and documenting the driver s medical examination
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
NRCMEDraft Guidance for Core Curriculum Specifications(5) Performing, obtaining and documenting diagnostic tests and obtaining additional testing or medical opinion from a medical specialist or treating physician
(6) Informing and educating the driver about medications and non-disqualifying medical conditions that require remedial care
(7) Determining driver certification outcome and period for which certification should be valid
(8) FMCSA reporting and documentation requirements
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Who can be a Medical Examiner• Medical examiner means a person who is
licensed, certified, and/or registered, in accordance with applicable State laws and regulations, to perform physical examinations. • The term includes, but is not limited to, doctors of
medicine and osteopathy, advanced practice nurses, physician assistants and chiropractors.
• Required to be trained and certified and listed on a national registry (May 21, 2014)
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Who Must be Examined• Medical certification in accordance with FMCSA physical
qualification standards is required when the driver is operating a commercial vehicle in interstate commerce that:• Has a combined gross vehicle weight or weight rating of 10,001 (not
10,0001) lbs. or more.
• Is designed or used to transport 9-15 passengers (including the driver) for compensation.
• Is designed or used to transport 16 or more passengers (including the driver) whether for compensation or not.
• Transports hazardous materials in quantities that require placarding under the hazardous materials regulations.
Intrastate drivers may be required by thei r state to meet FMCSA medical criteria. May have different criteria for variances
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Interstate Commerce• Refers to property not
operator• Cargo interstate – driver
must meet criteria• Tools and vehicle may be
considered property ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Who Must be Examined – 391.45(a) Any person who has not been medically examined and certified as physically qualified to operate a commercial motor vehicle;
(b)(1) Any driver who has not been medically examined and certified as qualified to operate a commercial motor vehicle during the preceding 24 months; or
(2) Any driver authorized to operate a commercial motor vehicle only with an exempt intracity zone pursuant to §391.62, or only by operation of the exemption in §391.64, if such driver has not been medically examined and certified as qualified to drive in such zone during the preceding 12 months; and
(c) Any driver whose ability to perform his/her normal duties has been impaired by a physical or mental injury or disease.
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Who Must be Examined• When a driver returns from an illness or injury that
interferes with driving ability, the driver must undergo a medical examination even if the medical examiner's certificate has not expired.
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Duration of Certification• Certification cannot exceed two years
• At discretion of examiner• Guidance as per ME Handbook
• Federal Vision and Diabetes Exemption Programs require annual medical certification.
• The medical examiner's certificate expires at midnight of the day, month, and year written on the certificate. • No grace period on the expiration
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Who - Responsibility• Determining medical qualification
• Responsibility of examiner• Ensuring that medical examiner has medical
requirements and type of work• Responsibility of carrier
• Ensuring Driver is medically qualified• Responsibility of the carrier
From interpretati on for 391.41
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Stress Factors affecting drivers• Type of Route• Schedules• Environment• Types of cargo
Details in pre-read ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Driver’s duty may include:• Coupling and uncoupling trailer(s) from
tractors• Loading and unloading• Inspecting vehicle and trailer• Lifting, installing and removing chains,
tarps• Bend, stoop, couching, climb
Details in pre-read
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Driver must have:• Perceptual skills to monitor complex driving
situation• Judgment skills to make quick decisions• Manipulative skills to control an oversize steering
wheel, shift gears and maneuver vehicle in crowded areas.
Reporting Report ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
The Driving Task
Dr. Stephen Treager
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Federal Motor Carrier Safety Regulations 49 CFR 390 - General• Subpart A – General Applicability and definitions
• 390.3
• (d) Additional requirements. Nothing in Subchapter B of this chapter shall be construed to prohibit an employer from requiring and enforcing more stringent requirements relating to safety of operation and employee safety and health. (CD Note- ADAAA)
• 390.5 – Definitions• 390.101 – 115 – National Registry of Certified Medical
Examiners
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
National Registry of Certified Medical Examiners –390.101-115390.101 Scope.
390.103 Eligibility requirements for medical examiner certification
390.105 Medical examiner training programs
390.107 Medical examiner certification testing
390.109 Issuance of the FMCSA medical examiner certification credential
390.111 Requirements for continued listing on the National Registry of Certified Medical Examiners
390.113 Reasons for removal from the National Registry of Certified Medical Examiners
390.115 Procedure for removal from the National Registry of Certified Medical Examiners
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Federal Motor Carrier Safety Regulations 49 CFR 391 - Subpart E -- Physical Qualifications and Examinations 391.41--Physical qualifications for drivers.391.42 - Schedule for use of medical examiners listed on the National Registry of Certified Medical Examiners.391.43--Medical examination; certificate of physical examination.391.45--Persons who must be medically examined and certified.391.47--Resolution of conflicts of medical evaluation.391.49--Alternative physical qualification standards for the loss or impairment of limbs.
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
§391.42 Schedule for use of medical examiners listed on the National Registry of Certified Medical Examiners• On and after May 21, 2014, each medical examination required
under this subpart must be conducted by a medical examiner who is listed on the National Registry of Certified Medical Examiners.
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Federal Motor Carrier Safety Regulations • 49 CFR 391 Subpart G -- Limited Exemptions
• 391.61--Drivers who were regularly employed before January 1, 1971.
• 391.62--Limited exemptions for intra-city zone drivers.• 391.63--Multiple-employer drivers.• 391.64--Grandfathering for certain drivers participating in vision and
diabetes waiver study programs.
• 381 – Waivers, Exemptions and Pilot Programs• 382 – Alcohol and Controlled Substances• 383 – Commercial Drivers License
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Purpose of the CDME• “Medical fitness for duty" examination• To detect the presence of any physical, mental, or organic
conditions of such character and extent as to affect the ability of the driver to operate a CMV safely.
• Obligation of ME 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• Over the duration of the Medical Certification (CD Note)
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Concern :
The risk of Impairment/incapacitation
Sudden
Gradual
During the validity period of the Medical Certificate
Fitness Criteria
To determine that must have medical training to understand the diagnosis, treatment and prognosi s of the medical condi tions you are evaluating. Goes well beyond the NRCME training.(IMHO)
From ME Handbook
• REMEMBER: Medical fitness for duty includes the ability to perform strenuous labor. Overall requirements for commercial drivers, as well as the specific requirements in the job description of the driver, should be deciding factors in the certification process.
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Acceptable Risk• Acceptable risk is a medical and societal issue“Given the complex demands of operating a large
truck or bus, coupled with the high fatality risk for occupants of the other vehicle in crashes involving CMVs, a conservative approach is required.”
• 1% annual risk of sudden incapacitation (impairment) is often used
From Cardiovascular Advisory Panel
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Medical Examiner Role• Responsible for ensuring that only drivers who meet Federal physical
requirements are issued a Medical Examiner’s Certificate• Certifying that the driver is medically fit for duty• Can perform the driver role as described in the Medical Examination
Form• May certify for maximum of 2 years
• Certify for less if more frequent monitoring is required to ensure medical fitness for duty.
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
3636
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Review Form Completion• Details on Form completion also in Post-Read
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
When do I do what?• Form - December 22, 2015 – April 20, 2016 – Either• Submit determination by;
• By end of month following the examination -Now until June 22, 2018• Close of business following CALENDAR day - Beginning June 22, 2018
• Provide paper copy of certificate to driver• Until June 22, 2018• After June 22, 2018 no longer required to provide to CLP/CDL holder or
applicants• Continue to provide to those that are not CDL/CLP holder/applicants
and are operating in intrastate commerce.
Forms• Medical Examiner Report Form – MER – MCSA - 5875• Medical Examiners Certificate – MEC – MCSA-5876 • Submission of Determination (online) -
Key Points• Medical record number – can be whichever number
examiner uses to maintain medical records• Driver reminded that providing this information is
mandatory• Each original (paper or electronic) must be maintained at
the office of the Medical Examiner for at least 3 years• Locum tenens – AT EXAMINERS OFFICE
Personal Information and Drive Health HistoryKey Points• Driver’s license number and ID verified
• May or may not be CDL #• FMCSA working with states to ensure unique, different states have
different formats• Optional email• CLP/CDL applicant/holder – Required to declare to state• Has your USDOT/FMCSA Medical Certificate ever been issued for less than two
years?• Not Sure????
Page 2 with Driver Health HistoryKey Points • Exam Date – Date exam performed (started), not date determination made• Have you ever; had a sleep test; spent a night in the hospital; failed a drug test.• Driver signs;
• “I certify that the above information is accurate and complete. I understand that inaccurate, false or misleading information may invalidate the examination and my Medical Examiner’s Certificate, that submission of fraudulent or intentionally false information is a violation of 49 CFR 391.35 and that submission of fraudulent or intentionally false information may subject me to civil or criminal penalties under 49 CFR 390.37 and 59 CFR 386
• “Not sure” response
What Should Examiner Do with Not Sure• Evaluate whether makes sense• Seek additional information?• Not make determination until comfortable?• Remember driver signs that “Providing Information is
Mandatory”• See also page 2
• FAQ still references False or Misleading statement• Examiner cannot amend responses
Page 3 and TestingKey Points• No BMI
• Does not mean can’t be added• Bulletin to examiners does indicate that MEs “should consider BMI and neck size “
• No blood pressure guideline chart
• Blood Pressure guidelines not on form, part of advisory criteria• “ The blood pressure guidelines are not, nor have they ever been,
regulatory in nature. FMCSA leaves blood pressure criteria decisions up to the discretion of the ME to determine driver qualification.”
• But are part of the advisory criteria
Not Medical Examiners Certification expiration
Date MER Amended
Medical Examination DeterminationKey Point• Driver and employer responsibility to ensure that any
exemption/variance is obtained• Still employers responsibility to age and language
• Medical Examiners Certificate Expiration Date • Examiner signs that – “I have performed this evaluation for
certification. I have personally reviewed all available records and recorded information pertaining to this evaluation and attest that to the best of my knowledge, I believe it to be true and correct”
Medical Examination DeterminationKey Point• Federal OR State – only complete one• Can use Federal if driver meets 49 CFR 391.41 criteria• Should NOT use State if driver required to meet 49CFR391.41
• Defined by 49CFR390.5• Interstate COMMERCE, not scope of driving• Should NOT use State as a restriction
• State does not have ”determination pending”• Examiner MUST know state variances for states where driver
operating
Not Medically Qualified
• Driver has not completed appropriate waiting period• Temporary condition which disqualifies• Long term condition which disqualifies
Not Medically Qualified • ME must:
• Inform the person examined of the determination• Inform driver that this will be reported to FMCSA• All MECs previously issued to the driver are invalid and no
longer satisfy the requirements of § 391.41(a). • FMCSA will transmit this report to the SDLA. • Driver required to be medically examined and certified before
operating a CMV
Determination Pending• Up to 45 days to obtain information to make determination • Determination Pending status reported to FMCSA.
• Do not issue MEC
• If not updated within 45 days, examination no longer valid and new examination required
• FMCSA notifies examiner and driver• Examiner amends MER as “incomplete”, not required to submit new 5850
What does the Driver do while in Determination Pending• The driver may continue to operate a CMV if and
WHILE he/she has a current valid MEC.• Expired or expiring certificate, may NOT drive
MER AmendedFederal Only• MER can ONLY be amended while in “Determination Pending”.
• Cannot amend if examination > 45 days prior• Can be updated by different examiner in the same practice with access to
the initial information.
• Provide reason, sign and DATE (date of amended)• Initial and date any changes made on the original MER• Submit new 5850 with determination date.• Calculate expiration date on date of determination
• Driver can stop exam at any time• Examiner reports incomplete examination
• NOT for when examination is completed but attempt to avoid determination
• FMCSA maintains incomplete examination informationFMCSA will review when two or more conflicting certifications
submittedIMHO – Do not discuss determination or duration until examination complete
Incomplete Evaluation
*scope of practi ce may require termination of examination
Examiner CertificateKey Points• Exam date does not appear on the certificate• Indicate date certificate signed
Reporting –CMDE Determination - INTRAState• In States that allow variances ME MAY transmit
information about examinations performed in accordance with the Federal Motor Carrier Safety Regulations (FMCSRs) with any applicable State variances. • ME must be aware of what variances are permitted by each
state• Not to be used as a restriction
• Based on commerce, not scope of driving
Can Examiner Modify Report or Certificate?• Permissible
• Add bar code to MER as long as does not interfere• Can resize as long as readable.• Can made instructions available or store separate from MER• And can reduce size of MEC provided readable• Can use additional page for information
• Prohibited • May not alter, add to or eliminate anything• Cannot add questions or company logo
Significant Differences – New form/process• No Temporary DQ• Determination Pending/Amended Report• Incomplete examination option• Full exam needed once a determination is made
• Any duration• Examiner discretion on duration (even if sequential 3-month
certification)• Expiration based on date of determination
Reminder to Examiners• Must keep contact and licensing information up to
date • If license expired or your name changes, MUST put the
correct information into the National Registry. • EXAMINERS must maintain copy of medical
examination* Reportedly FMCSA did not have current email for all examiners
Physical Qualifications for Drivers49CFR 391.41a. A person shall not drive a motor vehicle, unless
he is physically qualified to do so and, except as provided in 391.67, has on his person the original, or a photographic copy, of a medical examiner’s certificate that he is physically qualified to drive a motor vehicle.
b.A person is physically qualified to drive a motor vehicle if that person –
Will be reviewed with applicable module, all listed in handout
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Physical Qualifications for Drivers49CFR 391.41a. A person shall not drive a motor vehicle, unless
he is physically qualified to do so and, except as provided in 391.67, has on his person the original, or a photographic copy, of a medical examiner’s certificate that he is physically qualified to drive a motor vehicle.
b. A person is physically qualified to drive a motor vehicle if that person -
72
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Physical Qualifications for Drivers49CFR 391.411. Has no loss of a foot, a leg, a hand, or an arm, or has been
granted a skill performance evaluation certificate pursuant to 391.49;
2. Has no impairment of :(i) A hand or finger which interferes with prehension or power
grasping; or(ii) An arm, foot, or leg which interferes with the ability to
perform normal tasks associated with operating a motor vehicle; or any other significant limb defect or limitation which interferes with the ability to perform normal tasks associated with operating a motor vehicle; or has been granted a skill performance evaluation certificate pursuant to 391.49; 73
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Physical Qualifications for Drivers49CFR 391.413. Has no established medical history or clinical
diagnosis of diabetes mellitus requiring insulin for control;
4. Has no current clinical diagnosis of myocardial infarction, angina pectoris, coronary insufficiency, thrombosis, or any other cardiovascular disease of a variety known to be accompanied by syncope, dyspnea, collapse, or congestive cardiac failure; 74
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Physical Qualifications for Drivers49CFR 391.415. Has no established medical history or clinical
diagnosis of a respiratory dysfunction likely to interfere with his ability to control and drive a motor vehicle safely;
6. Has no current clinical diagnosis of high blood pressure likely to interfere with his ability to operate a motor vehicle safely; 75
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Physical Qualifications for Drivers49CFR 391.417. Has no established medical history or clinical
diagnosis of rheumatic, arthritic, muscular, neuromuscular, or vascular disease which interferes with his ability to control and operate a motor vehicle safely;
8. Has no established medical history or clinical diagnosis of epilepsy or any other condition which is likely to cause loss of consciousness or any loss of ability to control a motor vehicle;
76
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Physical Qualifications for Drivers49CFR 391.419. Has no mental, nervous, organic, or functional disease or psychiatric
disorder likely to interfere with his ability to drive a motor vehicle safely;
10. Has distant visual acuity of at least 20/40 (Snellen) in each eye without corrective lenses or visual acuity separately corrected to 20/40 (Snellen) or better with corrective lenses, distant binocular 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, and the ability to recognize the colors of traffic signals and devices showing standard red, green, and amber; 77
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Physical Qualifications for Drivers49CFR 391.4111. First perceives a forced whispered voice in the
better ear at not less than 5 feet with or without the use of a hearing aid or, if tested by use of an audiometric device, does not have an average hearing loss in the better ear greater than 40 decibels at 500 Hz, 1,000 Hz, and 2,000 Hz with or without a hearing aid when the audiometric device is calibrated to American National Standard Z24.5-1951; 78
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Physical Qualifications for Drivers49CFR 391.4112.(i) Does not use any drug or substance identified in
21 CFR 1308.11 Schedule I, an amphetamine, a narcotic, or other habit-forming drug.
(ii) Does not use any non-Schedule I drug or substance that is identified in the other Schedules in 21 part 1308 except when the use is prescribed by a licensed medical practitioner, as defined in §382.107, who is familiar with the driver's medical history and has advised the driver that the substance will not adversely affect the driver's ability to safely operate a commercial motor vehicle
13. Has no clinical diagnosis of alcoholism79
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Medical Certification - FAQ• Medical certification granted to perform any job
duty required of a commercial driver, not just current job
• Medical examiners cannot grant waivers• Regulations do not address fees for examination
or who must pay• If certificate is lost or damaged
• Driver may request copy from examiner or carrier
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Medical Certification - FAQ• Medical Examiner who performs the
examination must sign the certificate• If certifying examiner us no longer available,
examiner in office may sign the replacement certificate
• Copy of original can be given to driver• Some examiners may require a new
examination
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Resolution of Conflicts of Medical Evaluation391.47• Must be disagreement between examiners• Must submit opinions and reports from impartial specialist
• Agreed to by motor carrier and driver• Submits to Director of Office of Motor Carrier Research and
Standards• Disqualified until decision made
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Standard Statements on Medical Certification Determination• You should not certify the driver until
etiology is confirmed and treatment has been shown to be adequate/effective, safe, and stable.
• NOTE: If more than one waiting period applies (because of multiple cardiac conditions or other comorbid diseases), examine the driver for certification after the completion of the longest waiting period
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Standard Statements on Medical Certification Determination• You may on a case-by-case basis obtain
additional tests and/or consultation to adequately assess driver medical fitness for duty.
• The driver should have follow-up dependent upon the clinical course of the condition and recommendation of the treating healthcare provide
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
HIPAA• FMCSA - medical information best maintained by
the medical examiner• 49 CFR 391.43(h) indicates that completed medical
examination on file in ME office• FMCSA does not prohibit employers from obtaining
copies of the form• Employers must comply with applicable State and
Federal laws regarding the privacy and maintenance of employee medical information
• Authorization is required to release long form
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Resources for Medical Evaluation of Commercial Drivers• Federal Motor Carrier Safety Regulations (FMCSRs)
• Advisory Criteria – on Form• Interpretations• FAQs
• Conference / Advisory Panel Reports• Medical Examiner Handbook
• “Official”
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
http://nrcme.fmcsa.dot.g ov/documents /FMCSAMedicalExaminerHandbook-2014MAR18.pdf
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
•All that follows is information previously not issued by FMCSA and NOT adopted by FMCSA
•Will not be on examination
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Resources for Medical Evaluation of Commercial Drivers• Medical Expert Panel Reports• Medical Review Board Recommendations
• Motor Carrier Safety Advisory Committee• Medical Literature
Not from FMCSA, Not requirements
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Medical Review BoardNo regulatory responsibility• Define issues for consideration by the MRB • Provide FMCSA with ongoing medical expertise• Advise FMCSA on the development of uniform driver physical
qualification standards and CMV driver health and wellness; • Advise FMCSA on the development of scientific guidelines, criteria,
and procedures
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Medical Review Board ProceedingsOften include MEP presentations
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Fitness for Duty – MRB Recommendation
96MRB Recommendation – NOT adopted by FMCSA
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Post Read• Review of;
• Completion of Medical Examination Report and Certificate
• Certification Determination• Interpretations under FMCSRs• FMCSA– FAQs Medical• NRCME- FAQs • NRCME Fact Sheet
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
FMCSA Overview Recall• What is the purpose of the Interstate CMV driver
physical examination? • The purpose of the driver 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 the Federal Motor Carrier Safety Administration (FMCSA) to be a “medical fitness for duty" examination.
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
FMCSA Overview Recall• What is the mission of the FMCSA?
• "The Federal Motor Carrier Safety Administration (FMCSA) is focused on reducing crashes, injuries, and fatalities involving large trucks and buses.“
• Who and what does FMCSA regulate?• The FMCSA regulates interstate commercial operation,
including the driver, vehicle, motor carrier, and the transport of hazardous materials.
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
FMCSA Overview Recall• Give examples of CMV driver stress factors.
• Stress factors may include:• Interruption of normal sleep, exercise, and eating
patterns and access to social support networks resulting in fatigue, obesity, and/or alienation of affection.
• Environment that may have excessive vibration, noise, and extremes in temperature, and/or adverse road or traffic conditions can interfere with driver ability to recognize a driving hazard, cause temporary or permanent physical damage to sensory perception or affect driver behavior.
• Increased potential for injury and fatalities should there be a crash when driver is responsible for passenger safety or hazardous cargo.
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
FMCSA Overview Recall• What are the differences between the medical
standards and the medical guidelines?• The regulations are law. The medical examiner
must use the standards found in 49 CFR 391. 41 to determine interstate CMV driver medical fitness for duty. Medical guidelines are based on expert review and considered best practices and are intended to assist the medical examiner in determining driver certification.
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
FMCSA Overview Recall• In which regulation(s) are the driver physical
qualification standards and medical examiners responsibilities cited?• Driver physical qualification standards are
found in 49 CFR 391.41. Medical examiner responsibilities are found in 49 CFR 391.43.
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
FMCSA Overview Recall• What objective tests and measurements are required as
part of the driver physical examination.• Height and weight.• Vision.• Hearing.• Blood pressure and pulse.• Urinalysis (dipstick) for specific gravity, protein, blood,
and glucose. ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
FMCSA Overview Recall• What are the possible outcomes of the driver
physical examination?• Certification• Disqualification
• What date is used to determine medical examiner’s certificate expiration?• Date noted on the medical examination report
form; the day the physical examination was started.
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
FMCSA Overview RecallWhat is the medical examiner certificate expiration date for the following drivers?• Driver A – Examination 4/16/2011 – Meets standards in 49
CFR 391.41; qualifies for 2 year certificate.• Expiration date 4/16/2013 (2 years from date of physical
examination).
• Driver B – Examination 4/16/2011 – Meets standards, but periodic monitoring required due to hypertension – driver qualified for 1 year.• Expiration date 4/16/2012 (1 year from date of physical
examination).
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
FMCSA Overview RecallWhat is the medical examiner certificate expiration date for the following drivers?• Driver C – Examination 4/16/2011 – Disqualified due to
not having results of post-CABG stress test for review (had completed waiting period.) • 4/25/2011 – Return to medical examiner’s office
with test results (attached to examination) – driver qualified for 1 year.
• Expiration date 4/16/2012 (1 year from date the physical examination was started, not the follow-up date when driver returned with test results needed to complete physical examination).
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
FMCSA Overview RecallWhat is the medical examiner certificate expiration date for the following drivers?• Driver D – Examination 4/16/2011 – Disqualified due to diagnosis
of benign positional vertigo 3/15/2011• Return to medical examiner’s office for Certification Examination on
5/20/2011 with note - asymptomatic since 3/11/2011 but periodic evaluation – driver qualified for 2 years.
• Expiration date 5/20/2013 (Time and conditions of waiting periods should be completed before considering the driver for certification.
• Medical examiner disqualified the driver, explaining that a 2 month, symptom-free waiting period must elapse.
• Medical examiner performed a complete physical examination, including starting a new Medical Examination Report form, on 5/20/2011 and determined the driver could be certified for 2 years.
• Expiration date is 2 years from the date the examination was performed).
ACO
EM/H
arte
nbau
m C
DM
E C
ours
e 20
16 ©
Page 1
Form MCSA-5875 OMB No. 2126-0006 Expiration Date: 8/31/2018
Medical Examination Report Form (for Commercial Driver Medical Certification)
U.S. Department of Transportation Federal Motor Carrier Safety Administration
Public Burden Statement A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2126-0006. Public reporting for this collection of information is estimated to be approximately 25 minutes per response, including the time for reviewing instructions, gathering the data needed, and completing and reviewing the collection of information. All responses to this collection of information are mandatory. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal Motor Carrier Safety Administration, MC-RRA, 1200 New Jersey Avenue, SE, Washington, D.C. 20590.
MEDICAL RECORD #
(or sticker)SECTION 1. Driver Information (to be filled out by the driver)
Last Name: First Name: Middle Initial: Date of Birth: Age:
Street Address: City: State/Province: Zip Code:
Driver's License Number: Issuing State/Province: Phone: Gender: M F
E-mail (optional): CLP/CDL Applicant/Holder*: Yes No
Driver ID Verified By**:
Has your USDOT/FMCSA medical certificate ever been denied or issued for less than 2 years? Yes No Not Sure
*CLP/CDL Applicant/Holder: See instructions for definitions. **Driver ID Verified By: Record what type of photo ID was used to verify the identity of the driver, e.g., CDL, driver's license, passport.
DRIVER HEALTH HISTORY
Have you ever had surgery? If "yes," please list and explain below. Yes No Not Sure
Are you currently taking medications (prescription, over-the-counter, herbal remedies, diet supplements)? If "yes," please describe below.
Yes No Not Sure
PERSONAL INFORMATION
**This document contains sensitive information and is for official use only. Improper handling of this information could negatively affect individuals. Handle and secure this information appropriately to prevent inadvertent disclosure by keeping the documents under the control of authorized persons. Properly dispose of this document when no longer required to be maintained by regulatory requirements.**
(Attach additional sheets if necessary)
Page 2
Form MCSA-5875 OMB No. 2126-0006 Expiration Date: 8/31/2018
Last Name: First Name: DOB: Exam Date:
DRIVER HEALTH HISTORY (continued)
Do you have or have you ever had: Yes NoNot Sure
1. Head/brain injuries or illnesses (e.g., concussion)
2. Seizures, epilepsy
3. Eye problems (except glasses or contacts)
4. Ear and/or hearing problems
5. Heart disease, heart attack, bypass, or other heart problems
6. Pacemaker, stents, implantable devices, or other heart procedures
7. High blood pressure
8. High cholesterol
9. Chronic (long-term) cough, shortness of breath, or other breathing problems
10. Lung disease (e.g., asthma)
11. Kidney problems, kidney stones, or pain/problems with urination
12. Stomach, liver, or digestive problems
13. Diabetes or blood sugar problems
Insulin used
14. Anxiety, depression, nervousness, other mental health problems
15. Fainting or passing out
Yes NoNot Sure
16. Dizziness, headaches, numbness, tingling, or memory loss
17. Unexplained weight loss
18. Stroke, mini-stroke (TIA), paralysis, or weakness
19. Missing or limited use of arm, hand, finger, leg, foot, toe
20. Neck or back problems
21. Bone, muscle, joint, or nerve problems
22. Blood clots or bleeding problems
23. Cancer
24. Chronic (long-term) infection or other chronic diseases
25. Sleep disorders, pauses in breathing while asleep, daytime sleepiness, loud snoring
26. Have you ever had a sleep test (e.g., sleep apnea)?
27. Have you ever spent a night in the hospital?
28. Have you ever had a broken bone?
29. Have you ever used or do you now use tobacco?
30. Do you currently drink alcohol?
31. Have you used an illegal substance within the past two years?
32. Have you ever failed a drug test or been dependent on an illegal substance?
Other health condition(s) not described above: Yes No Not Sure
Did you answer "yes" to any of questions 1-32? If so, please comment further on those health conditions below. Yes No Not Sure
CMV DRIVER'S SIGNATURE
I certify that the above information is accurate and complete. I understand that inaccurate, false or missing information may invalidate the examination and my Medical Examiner's Certificate, that submission of fraudulent or intentionally false information is a violation of 49 CFR 390.35, and that submission of fraudulent or intentionally false information may subject me to civil or criminal penalties under 49 CFR 390.37 and 49 CFR 386 Appendices A and B.
Driver's Signature: Date:
SECTION 2. Examination Report (to be filled out by the medical examiner)
DRIVER HEALTH HISTORY REVIEW
Review and discuss pertinent driver answers and any available medical records. Comment on the driver's responses to the "health history" questions that may affect the driver's safe operation of a commercial motor vehicle (CMV).
(Attach additional sheets if necessary)
(Attach additional sheets if necessary)
Page 3
Form MCSA-5875 OMB No. 2126-0006 Expiration Date: 8/31/2018
Last Name: First Name: Exam Date:DOB:
TESTING
Pulse rate: Pulse rhythm regular: Yes No Height: feet inches Weight: pounds
Blood Pressure Systolic Diastolic
Sitting
Second reading (optional)
Other testing if indicated
Urinalysis Sp. Gr. Protein Blood Sugar
Urinalysis is required. Numerical readings must be recorded.
Protein, blood, or sugar in the urine may be an indication for further testing to rule out any underlying medical problem.
VisionStandard is at least 20/40 acuity (Snellen) in each eye with or without correction. At least 70° field of vision in horizontal meridian measured in each eye. The use of cor-rective lenses should be noted on the Medical Examiner's Certificate.
Acuity Uncorrected Corrected Horizontal Field of Vision
Right Eye: 20/ 20/ Right Eye: degrees
Left Eye: 20/ 20/ Left Eye: degrees
Both Eyes: 20/ 20/ Yes NoApplicant can recognize and distinguish among traffic control signals and devices showing red, green, and amber colors
Monocular vision
Referred to ophthalmologist or optometrist?
Received documentation from ophthalmologist or optometrist?
HearingStandard: Must first perceive whispered voice at not less than 5 feet OR average hearing loss of less than or equal to 40 dB, in better ear (with or without hearing aid).
Check if hearing aid used for test: Right Ear Left Ear NeitherWhisper Test Results
Record distance (in feet) from driver at which a forced whispered voice can first be heard
Right Ear Left Ear
OR
Audiometric Test ResultsRight Ear Left Ear
500 Hz 1000 Hz 2000 Hz 500 Hz 1000 Hz 2000 Hz
Average (right): Average (left):
PHYSICAL EXAMINATIONThe presence of a certain condition may not necessarily disqualify a driver, particularly if the condition is controlled adequately, is not likely to worsen, or is readily amenable to treatment. Even if a condition does not disqualify a driver, the Medical Examiner may consider deferring the driver temporarily. Also, the driver should be advised to take the necessary steps to correct the condition as soon as possible, particularly if neglecting the condition could result in a more serious illness that might affect driving. Check the body systems for abnormalities.
Body System Normal Abnormal1. General
2. Skin
3. Eyes
4. Ears
5. Mouth/throat
6. Cardiovascular
7. Lungs/chest
Body System Normal Abnormal8. Abdomen
9. Genito-urinary system including hernias
10. Back/Spine
11. Extremities/joints
12. Neurological system including reflexes
13. Gait
14. Vascular system
Discuss any abnormal answers in detail in the space below and indicate whether it would affect the driver's ability to operate a CMV. Enter applicable item number before each comment.
(Attach additional sheets if necessary)
Page 4
Form MCSA-5875 OMB No. 2126-0006 Expiration Date: 8/31/2018
Last Name: First Name: Exam Date:DOB:
Please complete only one of the following (Federal or State) Medical Examiner Determination sections:
MEDICAL EXAMINER DETERMINATION (Federal)
Use this section for examinations performed in accordance with the Federal Motor Carrier Safety Regulations (49 CFR 391.41-391.49):
Does not meet standards (specify reason):
Meets standards in 49 CFR 391.41; qualifies for 2-year certificate
Meets standards, but periodic monitoring required (specify reason):
Driver qualified for: 3 months 6 months 1 year other (specify):
Wearing corrective lenses Wearing hearing aid Accompanied by a waiver/exemption (specify type):
Accompanied by a Skill Performance Evaluation (SPE) Certificate Qualified by operation of 49 CFR 391.64 (Federal)
Driving within an exempt intracity zone (see 49 CFR 391.62) (Federal)
Determination pending (specify reason):
Return to medical exam office for follow-up on (must be 45 days or less):
Medical Examination Report amended (specify reason):
(if amended) Medical Examiner's Signature: Date:
Incomplete examination (specify reason):
If the driver meets the standards outlined in 49 CFR 391.41, then complete a Medical Examiner's Certificate as stated in 49 CFR 391.43(h), as appropriate.
I have performed this evaluation for certification. I have personally reviewed all available records and recorded information pertaining to this evaluation, and attest that to the best of my knowledge, I believe it to be true and correct.
Medical Examiner's Signature:
Medical Examiner's Name (please print or type):
Medical Examiner's Address: City: State: Zip Code:
Medical Examiner's Telephone Number: Date Certificate Signed:
Medical Examiner's State License, Certificate, or Registration Number: Issuing State:
MD DO Physician Assistant Chiropractor Advanced Practice Nurse
Other Practitioner (specify):
National Registry Number: Medical Examiner's Certificate Expiration Date:
Page 5
Form MCSA-5875 OMB No. 2126-0006 Expiration Date: 8/31/2018
Last Name: First Name: Exam Date:DOB:
MEDICAL EXAMINER DETERMINATION (State)
Use this section for examinations performed in accordance with the Federal Motor Carrier Safety Regulations (49 CFR 391.41-391.49) with any applicable State variances (which will only be valid for intrastate operations):
Does not meet standards in 49 CFR 391.41 with any applicable State variances (specify reason):
Meets standards in 49 CFR 391.41 with any applicable State variances
Meets standards, but periodic monitoring required (specify reason):
Driver qualified for: 3 months 6 months 1 year other (specify):
Wearing corrective lenses Wearing hearing aid Accompanied by a waiver/exemption (specify type):
Accompanied by a Skill Performance Evaluation (SPE) Certificate Grandfathered from State requirements (State)
If the driver meets the standards outlined in 49 CFR 391.41, with applicable State variances, then complete a Medical Examiner's Certificate, as appropriate.
I have performed this evaluation for certification. I have personally reviewed all available records and recorded information pertaining to this evaluation, and attest that to the best of my knowledge, I believe it to be true and correct.
Medical Examiner's Signature:
Medical Examiner's Name (please print or type):
Date Certificate Signed:
Medical Examiner's Address: City: State: Zip Code:
Medical Examiner's Telephone Number:
Medical Examiner's State License, Certificate, or Registration Number: Issuing State:
MD DO Physician Assistant Chiropractor Advanced Practice Nurse
Other Practitioner (specify):
National Registry Number: Medical Examiner's Certificate Expiration Date:
Page 6
Instructions MCSA-5875
Instructions for Completing the Medical Examination Report Form (MCSA-5875)
I. Step-By-Step Instructions
Driver:
Section 1: Driver information
· Personal Information: Please complete this section using your name as written on your driver's license, your current address and phone number, your date of birth, age, gender, driver's license number and issuing state.
o CLP/CDL Applicant/Holder: Check "yes" if you are a commercial learner's permit (CLP) or com-mercial driver's license (CDL) holder, or are applying for a CLP or CDL. CDL means a license issued by a State or the District of Columbia which authorizes the individual to operate a class of a commercial motor vehicle (CMV). A CMV that requires a CDL is one that: (1) has a gross combina-tion weight rating or gross combination weight of 26,001 pounds or more inclusive of a towed unit with a gross vehicle weight rating (GVWR) or gross vehicle weight (GVW) of more than 10,000 pounds; or (2) has a GVWR or GVW of 26,001 pounds or more; or (3) is designed to transport 16 or more passengers, including the driver; or (4) is used to transport either hazardous materials requiring hazardous materials placards on the vehicle or any quantity of a select agent or toxin.
o Driver ID Verified By: The Medical Examiner/staff completes this item and notes the type of photo ID used to verify the driver's identity such as, commercial driver's license, driver's license, or passport, etc.
o Question: Has your USDOT/FMCSA medical certificate ever been denied or issued for less than two years? Please check the correct box “yes” or “no” and if you aren't sure check the “not sure” box.
· Driver Health History:
o Have you ever had surgery: Please check “yes” if you have ever had surgery and provide a written explanation of the details (type of surgery, date of surgery, etc.)
o Are you currently taking medications (prescription, over-the-counter, herbal remedies, diet supplements): Please check “yes” if you are taking any diet supplements, herbal remedies, or prescription or over the counter medications. In the box below the question, indicate the name of the medication and the dosage.
o #1-32: Please complete this section by checking the “yes” box to indicate that you have, or have ever had, the health condition listed or the “No” box if you have not. Check the “not sure” box if you are unsure.
o Other Health Conditions not described above: If you have, or have had, any other health condi-tions not listed in the section above, check “Yes” and in the box provided and list those condition(s).
o Any yes answers to questions #1-32 above: If you have answered “yes” to any of the questions in the Driver Health History section above, please explain your answers further in the box below the question. For example, if you answered “yes” to question #5 regarding heart disease, heart attack, bypass, or other heart problem, indicate which type of heart condition. If you checked “yes” to ques-tion #23 regarding cancer, indicate the type of cancer. Please add any information that will be helpful to the Medical Examiner.
· CMV Driver Signature and Date: Please read the certification statement, sign and date it, indicating that the information you provided in Section 1 is accurate and complete.
Page 7
Instructions MCSA-5875
Medical Examiner:
Section 2: Examination Report
· Driver Health History Review: Review answers provided by the driver in the driver health history section and discuss any “yes” and “not sure” responses. In addition, be sure to compare the medication list to the health history responses ensuring that the medication list matches the medical conditions noted. Explore with the driver any answers that seem unclear. Record any information that the driver omitted. As the Medical Examiner conducting the driver's physical examination you are required to complete the entire medical examination even if you detect a medical condition that you consider disqualifying, such as deafness. Medical Examiners are expected to determine the driver's physical qualification for operating a commercial vehicle safely. Thus, if you find a disqualifying condition for which a driver may receive a Federal Motor Carrier Safety Administration medical exemption, please record that on the driver's Medical Examiner's Certificate, Form MCSA-5876, as well as on the Medical Examination Report Form, MCSA-5875.
· Testing:
o Pulse rate and rhythm, height, and weight: record these as indicated on the form.
o Blood Pressure: record the blood pressure (systolic and diastolic) of the driver being examined. A second reading is optional and should be recorded if found to be necessary.
o Urinalysis: record the numerical readings for the specific gravity, protein, blood and sugar.
o Vision: The current vision standard is provided on the form. When other than the Snellen chart is used, give test results in Snellen-comparable values. When recording distance vision, use 20 feet as normal. Record the vision acuity results and indicate if the driver can recognize and distinguish among traffic control signals and devices showing red, green, and amber colors; has monocular vision; has been referred to an ophthalmologist or optometrist; and if documentation has been received from an ophthalmologist or optometrist.
o Hearing: The current hearing standard is provided on the form. Hearing can be tested using either a whisper test or audiometric test. Record the test results in the corresponding section for the test used.
· Physical Examination: Check the body systems for abnormalities and indicate normal or abnormal for each body system listed. Discuss any abnormal answers in detail in the space provided and indicate whether it would affect the driver's ability to safely operate a commercial motor vehicle.
In this next section, you will be completing either the Federal or State determination, not both.
· Medical Examiner Determination (Federal): Use this section for examinations performed in accordance with the FMCSRs (49 CFR 391.41-391.49). Complete the medical examiner determination section completely. When determining a driver's physical qualification, please note that English language proficiency (49 CFR part 391.11: General qualifications of drivers) is not factored into that determination.
o Does not meet standards: Select this option when a driver is determined to be not qualified and provide an explanation of why the driver does not meet the standards in 49 CFR 391.41.
o Meets standards in 49 CFR 391.41; qualifies for 2-year certification: Select this option when a driver is determined to be qualified and will be issued a 2-year Medical Examiner's Certificate.
Page 8
Instructions MCSA-5875
o Meets standards, but periodic monitoring is required: Select this option when a driver is deter-mined to be qualified but needs periodic monitoring and provide an explanation of why periodic monitoring is required. Select the corresponding time frame that the driver is qualified and if select-ing other, specify the time frame.
· Determination that driver meets standards: Select all categories that apply to the driver's certification (e.g., wearing corrective lenses, accompanied by a waiver/exemption, driving within an exempt intracity zone, etc.).
o Determination pending: Select this option when more information is needed to make a qualification decision and specify a date, on or before the 45 day expiration date, for the driver to return to the medical exam office for follow-up. This will allow for a delay of the qualification decision for as many as 45 days. If the disposition of the pending examination is not updated via the National Regis-try on or before the 45 day expiration date, FMCSA will notify the examining medical examiner and the driver in writing that the examination is no longer valid and that the driver is required to be re-examined.
· MER amended: A Medical Examination Report Form (MER), MCSA-5875, may only be amended while in determination pending status for situations where new information (e.g., test results, etc.) has been received or there has been a change in the driver's medical status since the initial examination, but prior to a final qualification determination. Select this option when a Medic- al Examination Report Form, MCSA-5875, is being amended; provide the reason for the amendm- ent, sign and date. In addition, initial and date any changes made on the Medical Examination Report Form, MCSA-5875. A Medical Examination Report Form, MCSA-5875, cannot be amended after an examination has been in determination pending status for more than 45 days or after a final qualification determination has been made. The driver is required to obtain a new phys- ical examination and a new Medical Examination Report Form, MCSA-5875, should be completed.
o Incomplete examination: Select this when the physical examination is not completed for any reason (e.g., driver decides they do not want to continue with the examination and leaves) other than situations outlined under determination pending.
o Medical Examiner information, signature and date: Provide your name, address, phone number, occupation, license, certificate, or registration number and issuing state, national registry number, signature and date.
o Medical Examiner's Certificate Expiration Date: Enter the date the driver's Medical Examiner's Certificate (MEC) expires.
· Medical Examiner Determination (State): Use this section for examinations performed in accordance with the FMCSRs (49 CFR 391.41-391.49) with any applicable State variances (which will only be valid for intrastate operations). Complete the medical examiner determination section completely.
o Does not meet standards in 49 CFR 391.41 with any applicable State variances: Select this option when a driver is determined to be not qualified and provide an explanation of why the driver does not meet the standards in 49 CFR 391.41 with any applicable State variances.
o Meets standards in 49 CFR 391.41 with any applicable State variances: Select this option when a driver is determined to be qualified and will be issued a 2-year Medical Examiner's Certificate.
o Meets standards, but periodic monitoring is required: Select this option when a driver is deter-mined to be qualified but needs periodic monitoring and provide an explanation of why periodic monitoring is required. Select the corresponding time frame that the driver is qualified and if select-ing other, specify the time frame.
· Determination that driver meets standards: Select all categories that apply to the driver's certification (e.g., wearing corrective lenses, accompanied by a waiver/exemption, etc.).
Page 9
Instructions MCSA-5875
o Medical Examiner information, signature and date: Provide your name, address, phone number, occupation, license, certificate, or registration number and issuing state, national registry number, signature and date.
o Medical Examiner's Certificate Expiration Date: Enter the date the driver's Medical Examiner's Certificate (MEC) expires.
II. If updating an existing exam, you must resubmit the new exam results, via the Medical Examination Results Form, MCSA-5850, to the National Registry, and the most recent dated exam will take precedence.
III. To obtain additional information regarding this form go to the Medical Program's page on the Federal Motor Carrier Safety Administration's website at http://www.fmcsa.dot.gov/regulations/medical.
Form MCSA-5876 OMB No. 2126-0006 Expiration Date: 8/31/2018
Medical Examiner's Certificate (for Commercial Driver Medical Certification)
U.S. Department of Transportation Federal Motor Carrier Safety Administration
Public Burden Statement A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2126-0006. Public reporting for this collection of information is estimated to be approximately 1 minute per response, including the time for reviewing instructions, gathering the data needed, and completing and reviewing the collection of information. All responses to this collection of information are mandatory. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal Motor Carrier Safety Administration, MC-RRA, 1200 New Jersey Avenue, SE, Washington, D.C. 20590.
I certify that I have examined Last Name: First Name: in accordance with (please check only one):
the Federal Motor Carrier Safety Regulations (49 CFR 391.41-391.49) and, with knowledge of the driving duties, I find this person is qualified, and, if applicable, only when (check all that apply) ORthe Federal Motor Carrier Safety Regulations (49 CFR 391.41-391.49) with any applicable State variances (which will only be valid for intrastate operations), and, with knowledge of the driving duties,I find this person is qualified, and, if applicable, only when (check all that apply):
Wearing corrective lenses
Wearing hearing aidAccompanied by a waiver/exemptionAccompanied by a Skill Performance Evaluation (SPE) Certificate
Driving within an exempt intracity zone (49 CFR 391.62) (Federal)Qualified by operation of 49 CFR 391.64 (Federal)
Grandfathered from State requirements (State)
The information I have provided regarding this physical examination is true and complete. A complete Medical Examination Report Form, MCSA-5875, with any attachments embodies my findings completely and correctly, and is on file in my office.
Medical Examiner's Certificate Expiration Date
Medical Examiner's Signature Medical Examiner's Telephone Number Date Certificate Signed
Medical Examiner's Name (please print or type) MD
DO
Physician Assistant
Chiropractor
Advanced Practice Nurse
Other Practitioner (specify)
Medical Examiner's State License, Certificate, or Registration Number Issuing State National Registry Number
Driver's Signature Driver's License Number Issuing State/Province
CLP/CDL Applicant/Holder
Yes No
Driver's Address
Street Address: City: State/Province: Zip Code:
Medical Examiner’s Certification Integration Final Rule
Impact on Certified Medical Examiners
April 23, 2015: FMCSA published the Medical Examiner’s Certification Integration final rule.
June 22, 2015: No Exams Conducted Medical Examiners (MEs) must report to FMCSA, by close of business on the last day of the month, whenever the ME does not complete any examinations during that month. Driver Examination Forms MEs are required to continue to use the Medical Examination Report Form and Medical Examiner’s Certificate as found on the FMCSA website until December 22, 2015. Provide Driver with Medical Examiner’s Certificate MEs are required to continue to provide medically qualified commercial motor vehicle (CMV) drivers with a paper copy of the Medical Examiner’s Certificate.
Beginning December 22, 2015: Revised Driver Examination Forms MEs are required to use the revised driver examination forms accessible from the National Registry and FMCSA websites:
• Medical Examination Report (MER) Form, MCSA-5875
• Medical Examiner’s Certificate (MEC), Form MCSA-5876
Results of examinations conducted on or after December 22, 2015 must be reported using the revised electronic CMV Driver Medical Examination Results Form, MCSA-5850. When entering results of examinations conducted on or after December 22, 2015, the National Registry system will automatically present the ME with the revised version of the CMV Driver Medical Examination Results Form, MCSA-5850.
Provide Driver with MEC MEs are required to provide medically qualified CMV drivers with a paper copy of the MEC, Form MCSA-5876 so that Commercial Learner’s Permit (CLP)/Commercial Driver’s License (CDL) applicants/holders are able to provide a copy to the State Driver’s Licensing Agency (SDLA), and the non-CDL drivers are able to provide the documentation to their employers and Federal and State enforcement officials.
Determination Pending The determination pending status allows the ME up to 45 days to obtain additional medical information and/or examination results in order to make a determination as to whether or not the driver is physically qualified to drive a CMV in accordance with § 391.41(b). If used the ME is required to inform the driver that:
• Additional information must be provided or further examination must be completed within 45 days.
• The Determination Pending status will be reported to FMCSA.
The driver may continue to operate a CMV if he/she has a current valid MEC.
If the requested information and examination results are not completed and provided to the ME within 45 days:
• The examination will no longer be valid.
• The driver is required to obtain a new examination in order to obtain a MEC, Form 5876.
2015
Beginning June 22, 2018: Electronic Notification of Medical Qualification to SDLAs The MEC information for CLP/CDL applicants/holders will be electronically transmitted from the National Registry system to the SDLA, eliminating the need to issue a paper MEC to those drivers.
• MEs will still be required to provide the MEC, Form MCSA-5876 to non-CDL drivers and requesting employers, as currently required.
Daily Reporting MEs are required to report results of each interstate CMV driver’s physical examination, including the results of examinations where the driver was found not to be qualified, to FMCSA by midnight local time of the next calendar day following the examination.
• Includes all CMV drivers (CLP/CDL and Non-CLP/CDL) who are required to be medically certified to operate in interstate commerce.
• For intrastate drivers in States that allow variances, the ME may transmit information about examinations performed in accordance with the Federal Motor Carrier Safety Regulations (FMCSRs) with any applicable State variances.
Not Medically Qualified If the ME determines that the driver is not physically qualified to operate a CMV in accordance with § 391.41(b), the ME must:
• Inform the person examined of the determination.
• Inform the person examined that this information will be reported to FMCSA.
All MECs previously issued to the driver are invalid and no longer satisfy the requirements of § 391.41(a).
FMCSA will transmit this report to the SDLA.
The driver will be required to be medically examined and certified before operating a CMV.
2018
2017
2016
Medical Examiner’s Certification Integration Final Rule Changes that Impact Certified Medical Examiners
On April 23, 2015, the Federal Motor Carrier Safety Administration (FMCSA) published the Medical Examiner’s Certification Integration final rule which was a follow-on rule to both the National Registry final rule and the Medical Certification Requirements as Part of the Commercial Driver’s License final rule. Below is a summary of the changes that will impact Certified Medical Examiners (MEs) listed on the National Registry: June 22, 2015 No exams conducted - Certified MEs are now required to report to FMCSA, by close of business on the last day of the month, whenever the ME does not complete any examinations during that month. Driver Examination Forms - Certified MEs are required to continue to use the Medical Examination Report (MER) Form and Medical Examiner’s Certificate (MEC) as found on the FMCSA website at http://www.fmcsa.dot.gov/medical/driver-medical-requirements/medical-applications-and-forms. Certified MEs are required to continue to provide medically qualified commercial motor vehicle (CMV) drivers with a paper copy of the MEC. These forms are in effect until December 22, 2015. Examinations conducted up to December 22, 2015 Certified MEs are required to continue to use the current CMV Driver Medical Examination Results Form, MCSA-5850 when entering results for examinations conducted prior to December 22, 2015. Therefore, the National Registry system will automatically present the ME with the current version of the CMV Driver Medical Examination Results Form, MCSA-5850. December 22, 2015 Revised Driver Examination Forms - MEs are required to use the revised driver examination forms accessible from the FMCSA and National Registry websites: • Medical Examination Report (MER) Form, MCSA-5875
• Medical Examiner’s Certificate (MEC), Form MCSA-5876
Results of examinations conducted on or after December 22, 2015 must be reported using the revised electronic CMV Driver Medical Examination Results Form, MCSA-5850. Therefore, when entering results for examinations conducted on or after December 22, 2015, the National Registry system will automatically present the ME with the revised version of the CMV Driver Medical Examination Results Form, MCSA-5850. Provide Driver with MEC - MEs are required to provide medically qualified CMV drivers with a paper copy of the MEC, Form MCSA-5876 so that Commercial Learner’s Permit (CLP)/Commercial Driver’s License (CDL) Applicants/Holders are able to provide a copy to the State Driver’s Licensing Agency (SDLA), and the non-CDL drivers are able to provide the documentation to their employers and Federal and State enforcement officials. Determination Pending - The determination pending status allows the ME up to 45 days to obtain additional medical information and/or examination results in order to make a determination as to whether
or not the driver is physically qualified to drive a CMV in accordance with § 391.41(b). If used the ME is required to inform the driver that: • The additional requested information and examination results must be provided to the ME within 45
days.
• The Determination Pending status will be reported to FMCSA.
The driver may continue to operate a CMV if he/she has a current valid MEC. If the requested information and examination results are not completed and provided to the ME within 45 days: • The examination will no longer be valid.
• The driver is required to obtain a new examination in order to obtain a MEC, Form 5876. June 22, 2018 Electronic Notification of Medical Qualification to SDLAs - The MEC information for CLP/CDL applicants/holders will be electronically transmitted from the National Registry system to the SDLA, eliminating the need to issue a paper MEC to those drivers. • MEs will still be required to provide the MEC, Form MCSA-5876 to non-CDL drivers and requesting
employers, as currently required.
Daily Reporting - MEs are required to report results of each interstate CMV driver’s physical examination, including the results of examinations where the driver was found not to be qualified, to FMCSA by midnight local time of the next calendar day following the examination. • This requirement includes all CMV drivers (CLP/CDL and Non-CLP/CDL) who are required to be
medically certified to operate in interstate commerce.
• For intrastate drivers in States that allow variances, the ME may transmit any information about examinations performed in accordance with the Federal Motor Carrier Safety Regulations (FMCSRs) with any applicable State variances.
Not Medically Qualified - If the ME determines that the driver is not physically qualified to operate a CMV in accordance with § 391.41(b), the ME must: • Inform the person examined of the determination.
• Inform the person examined that this information will be reported to FMCSA.
All MECs previously issued to the driver are invalid and no longer satisfy the requirements of § 391.41(a). FMCSA will transmit this report to the SDLA. The driver will be required to be medically examined and certified before operating a CMV.
Changes to the CMV Driver Medical Examination Results Form MCSA- 5850
When entering results for examinations conducted prior to December 22, 2015, you will be presented with the current version of the CMV Driver Medical Examination Results Form, MCSA-5850. When entering results for examinations conducted on or after December 22, 2015, you will be presented with a revised version of the CMV Driver Medical Examination Results Form, MCSA-5850 (attached) based on the Medical Examiner’s Certification Integration Final Rule published on April 23, 2015. Areas highlighted in yellow indicate the changes that appear in the new form, which are explained below. Note: The attached CMV Driver Medical Examination Results Form, MCSA-5850 is a representation of the electronic form that will be available through your National Registry account. Therefore, it may not be identical to what you will see on your screen. In addition, some of the fields you see may not be visible on the electronic form because they are dependent on prior selections (e.g., Medical Examiner’s Certificate Expiration Date is only visible if Medically Qualified is selected). All information requested on the CMV Driver Medical Examination Results Form, MCSA-5850 can be found on the corresponding Medical Examination Report (MER) Form, MCSA-5875. CMV Driver’s Name and Address, the following have been added:
1. Street Address, City, State/Province, Zip code
2. Email – Enter driver’s email address if provided on the Medical Examination Report (MER) Form, MCSA-5875. This is optional and will only be used when FMCSA needs to communicate with the driver regarding their certification.
CMV Driver’s License Information, the following have been added:
1. Issuing State/Province – Province has been added to be used for non-CDL drivers from Canada. Enter the issuing State or Canada.
2. CDL yes/no has been expanded to CLP/CDL Applicant/Holder. Select yes when the driver has
selected yes on the MER indicating that they are a CLP or CDL holder or are applying for a CLP or CDL and no when the driver has selected no on the MER.
Examination Information, the following have been added:
1. Date MEC signed/issued for Medically Qualified - the date the ME signs and issues the MEC to the driver
2. Date of determination for Medically Unqualified – the date the driver is examined and the ME
makes the determination that he/she is medically unqualified
3. Determination Pending – date the driver is examined
4. Incomplete Examination – date the driver is examined
5. “Use this section for examinations performed in accordance with the Federal Motor Carrier Safety Regulations 49 CFR 391.41-391.49 with any applicable State variances (which will only be valid for intrastate operations).”
6. Date of Examination
7. Examination Result: Medically Qualified or Medically Unqualified
8. Medical Examiner’s Certificate Expiration Date
Restrictions and Variances Option for “Grandfathered from State Requirements (State).” This applies only to drivers examined in accordance with the Federal Motor Carrier Safety Regulations 49 CFR 391.41-391.49 with any applicable State variances (which will only be valid for intrastate operations).
Form MCSA-5850 (Revised: 11/19/2015) OMB No. 2126-0006 Expiration Date: 8/31/2018
CMV Driver Medical Examination Results FormU.S. Department of Transportation Federal Motor Carrier Safety Administration
Public Burden Statement A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2126-0006. Public reporting for this collection of information is estimated to be approximately 2 minutes per response, including the time for reviewing instructions, gathering the data needed, and completing and reviewing the collection of information. All responses to this collection of information are mandatory. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal Motor Carrier Safety Administration, MC-RRA, 1200 New Jersey Avenue, SE, Washington, D.C. 20590.
CMV Driver's Name and Address (use Legal Name as listed on Government-Issued Identification)
Last Name: First Name: Middle Initial:(enter 'NMN' if driver does not have a middle name)
Street Address: City: State/Province: Zip Code:
E-mail:(optional)
CMV Driver's License Information
Driver's License Number: Issuing State/Province: Date of Birth:(use mm/dd/yyyy format)
CLP/CDL Applicant/Holder: Yes No
Examination Information (please complete only one of the Examination Information sections below)
Use this section for examinations performed in accordance with the Federal Motor Carrier Safety Regulations (49 CFR 391.41-391.49):
Examination Result: Medically Qualified
Medically Unqualified
Determination Pending
Incomplete Examination
Date MEC signed/issued:(use mm/dd/yyyy format)
Date of examination/determination:(use mm/dd/yyyy format)
Date of examination:(use mm/dd/yyyy format)
Date of examination:(use mm/dd/yyyy format)
Medical Examiner's Certificate Expiration Date:(applicable when "Medically Qualified" is selected above) (use mm/dd/yyyy format)
or Use this section for examinations performed in accordance with the Federal Motor Carrier Safety Regulations (49 CFR 391.41-391.49), with any applicable State variances:
Date of Examination:(use mm/dd/yyyy format)
Examination Result: Medically Qualified
Medically Unqualified
Medical Examiner's Certificate Expiration Date:(applicable when "Medically Qualified" is selected above) (use mm/dd/yyyy format)
Restrictions and Variances (check all that apply)
Wearing corrective lenses
Wearing hearing aid
Accompanied by a waiver/exemption (specify type):
Accompanied by a Skill Performance Evaluation (SPE) Certificate
Driving within an exempt intracity zone (49 CFR 391.62) (Federal)
Qualified by operation of (49 CFR 391.64) (Federal)
Grandfathered from State requirements (State)SAMPLE
