Physical Qualification of Drivers; Medical Examination; Certificate

DEPARTMENT OF TRANSPORTATION

Federal Highway Administration

49 CFR Part 391

[FHWA Docket No. FHWA-98-3542]

RIN 2125-AC63

Physical Qualification of Drivers; Medical Examination;

Certificate

AGENCY: Federal Highway Administration (FHWA), DOT.

ACTION: Notice of proposed rulemaking (NPRM); request for comments.

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SUMMARY: The FHWA is seeking comments on a proposal to amend its

regulation governing the examination to determine the physical

condition of drivers. The FHWA takes this action in response to

numerous requests from medical examiners to update and simplify the

medical examination form that is currently used. This proposed action

is intended to reduce the incidence of errors on such forms and to

provide more uniform medical examinations of commercial motor vehicle

(CMV) drivers under the Federal Motor Carrier Safety Regulations

(FMCSRs). The current Federal physical qualification standards tested

by medical examiners and recorded on the form would not be revised in

this rulemaking. The FHWA is seeking comments on the proposed form.

DATES: Written comments addressing this rule must be received on or

before November 3, 1998.

ADDRESSES: Your signed, written comments must refer to the docket

number appearing at the top of this document and you must submit the

comments to the Docket Clerk, U.S. DOT Dockets, Room PL-401, 400

Seventh Street, SW., Washington, D.C. 20590-0001. All comments received

will be available for examination at the above address between 10 a.m.

and 5 p.m., e.t., Monday through Friday, except Federal holidays. Those

desiring notification of receipt of comments must include a self-

addressed, stamped envelope or postcard.

FOR FURTHER INFORMATION CONTACT: Mrs. Sandra Zywokarte, (202) 366-1790,

Office of Motor Carrier Standards, for information regarding the

rulemaking, or Ms. Judith A. Rutledge, (202) 366-0834, Motor Carrier

Law Division, Office of the Chief Counsel, for information regarding

legal issues. Federal Highway Administration, Department of

Transportation, 400 Seventh Street, SW., Washington, D.C. 20590. Office

hours are from 7:45 a.m. to 4:15 p.m., e.t., Monday through Friday,

except Federal holidays.

SUPPLEMENTARY INFORMATION:

Electronic Access

Internet users can access all comments received by the U.S. DOT

Dockets, Room PL-401, by using the universal resource locator (URL):

http://dms.dot.gov. It is available 24 hours each day, 365 days each

year. Please follow the instructions online for more information and

help.

An electronic copy of this document may be downloaded using a modem

and suitable communications software from the Federal Register

Electronic Bulletin Board Service at (202)512-1661. Internet users may

reach the Federal Register's home page at: http://www.nara.gov/nara/

fedreg and the Government Printing Office's database at: http://

www.access.gpo.gov/su__docs.

Background

The authority to require medical certification of CMV driver

qualification was originally granted to the Interstate Commerce

Commission (ICC) in the Motor Carrier Act of 1935. The authority was

transferred to the DOT in 1966 and is currently codified at 49 U.S.C.

31502(b).

The importance of physical qualification of commercial drivers was

recognized in 1939 when the first regulatory medical standard was

established by the ICC. Those

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regulations, published June 7, 1939, required a driver to possess the

following minimum qualifications:

Good physical and mental health; good eyesight; adequate

hearing; no addiction to narcotic drugs; and no excessive use of

alcoholic beverages or liquors.

The first change to this standard was initiated in 1952 and went

into effect on January 1, 1954. The Certificate of Physical Evaluation

required under the 1954 rule was slightly more specific than the 1939

regulation, and also required a physical examination form and a

doctor's certificate. A second revision made in 1964 amended the

standard to allow limb-amputee and limb-impaired drivers, who were

otherwise eligible, to become medically qualified through a waiver

program. On April 22, 1970, (35 FR 6458) in light of discussions with

the FHWA's medical advisors, the existing physical qualification

requirements were substantially tightened by including guidelines for

evaluation of persons in high-risk medical categories. This rule also

provided that the examining physician be given full information about

the responsibilities of and the exacting demands made on commercial

drivers. There have been no major changes since then.

Current Medical Examination Form

The current form was adopted by the DOT in 1970, recodified in 49

CFR part 391, and has undergone no changes since that time. The

physical qualification regulations for drivers in interstate commerce

are found at 49 CFR 391.41. Section 391.43 contains instructions to

medical examiners for performing physical examinations and recording

their findings.

The FHWA has received numerous verbal and written requests from

physicians and other medical providers who perform physical

examinations of CMV drivers engaged in interstate commerce to make

changes to the medical form currently used under Sec. 391.43(e).

Medical practitioners have indicated that the format, layout and

content of the current form are outdated, difficult to use and contain

irrelevancies. For example, the health history section of the form asks

about a history of fits, syphilis and gonorrhea, and nervous stomach.

Such inquiries reflect outdated terminology, are vague, or are not

relative to a driver's ability to operate a CMV safely. Others have

suggested that the form is not adaptable to current trends in

documentation such as electronic documentation. Given these comments,

the FHWA has decided to initiate this proposed rulemaking action.

Over the past two decades there have been substantial changes in

medical technology and the technology, operating practices and

economics of the motor carrier industry. These changes have affected

the lifestyles of and, therefore, the physical and mental demands

placed on CMV drivers. The FHWA agrees that the current form is

outdated and its continued use problematic.

Methods and Considerations for Developing a Revised Medical

Examination Form

The FHWA contracted with the Association for the Advancement of

Automotive Medicine (AAAM) to review and evaluate the current form, and

to help develop a revised form. In order to assure that the revised

form would reflect the most current medical concepts and be responsive

to the needs of the groups using the forms such as the medical

community and the trucking industry, the AAAM convened a working group

to review the draft form. This group included two occupational health

physicians, a motor carrier and Federal and State government

representatives. A second draft of the form was then submitted for

additional review by a correspondence review group made up of medical

providers, State agency representatives, motor carriers, FHWA field

staff, and other interested groups.

The form revision process was defined and limited by several norms.

The underlying physical qualification standards tested by medical

providers and recorded on the form would not be revised in this

rulemaking. In addition, the instructions for performing and recording

physical examinations found in 49 CFR 391.43 would be revised only to

the extent necessary to ensure that instructions to medical examiners

are understandable and consistent with the information provided on the

proposed medical examination form and guidance materials established by

the FHWA for medical examiners.

Proposed Medical Examination Form

The proposed form, modeled on physical examination forms in use

today, has been organized to gain simplicity and efficiency, to reflect

current medical terminology and examination components and to be a

self-contained document; that is, the proposed form will, to the extent

possible, include all relevant information necessary to conduct the

physical examination and certification. The FHWA believes its proposed

revision to the form will enhance the accuracy and efficiency of the

commercial driver physical qualification process.

Consistent with accepted practices regarding the order of the

examination, the first section of the proposed form would be completed

by the driver. This section requests information on the driver's health

history, seeking ``yes'' or ``no'' answers to a variety of medical

condition questions. Any ``yes'' response would require further

clarification by the driver. Once the form is completed, the driver

would be required to sign it, affirming that all the information

contained therein is accurate and complete. An additional statement

indicates that inaccurate, false, or missing information may invalidate

both the examination and any Medical Examiner's Certificate issued

thereon. A result of such invalidation could include revocation of the

driver's commercial license by the issuing State. The FHWA believes

that the proposed addition of a driver certification requirement would

discourage drivers from omitting or falsifying medical information and

thereby would ensure the accuracy and completeness of the medical form

and strengthen the overall certification process.

The second section of the proposed form covers the physical

examination and tests performed by the medical examiner. The medical

examiner is provided with information on both the relevant Federal

physical qualification standards and the tests required to measure

compliance with those standards. The Federal standards and guidelines

for evaluation of a driver's vision, hearing, and blood pressure are

included in this section of the proposed form, thereby reducing the

potential for errors by the medical examiner. Missing or inconsistent

information on the examination form has been a problem according to

anecdotal information provided by the motor carrier industry and other

users of the form, and according to information obtained from six pilot

demonstration programs to verify the six States' ability to merge the

medical process with the CDL licensing process. 1

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\1\ The pilot projects were completed in January 1995, and a

final report (see docket, FHWA-97-2210) was submitted to the FHWA.

On July 23, 1996, the FHWA announced (61 FR 38133) the first meeting

of a negotiated rulemaking advisory committee under the Federal

Advisory Committee Act and the Negotiated Rulemaking Act to consider

the relevant issues and attempt to reach a consensus in developing

regulations governing the proposed merger of the State-administered

commercial driver's license procedures and the Federal driver

physical qualification requirements. For complete information on the

six pilot projects and the negotiated rulemaking advisory committee

proceedings, see 59 FR 36338 (July 15,1994) and 61 FR 18713 (April

29, 1996).

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Unlike the current physical examination form, the proposed form

clearly indicates when numerical readings must be recorded. Moreover,

since the physical qualification regulations do not indicate acceptable

laboratory values for the presence of protein, blood or sugar in the

urine, the proposed form places the medical examiner on notice that the

presence of these substances in the urine may be an indication for

further testing to rule out an underlying medical condition that may be

disqualifying. Space is also provided for optional tests, such as an

electrocardiogram (ECG), an echocardiogram, an exercise stress test

(EST) or a chest x-ray. In addition, a complete physical examination

must be performed for each driver.

Although the ECG and EST are considered optional, the FHWA is

proposing specific recommendations for a baseline ECG at age 40, then

every six years until age 55, and then every two years. In this

proposal, the FHWA also recommends that an EST be given to asymptomatic

individuals who are 45 years old or older and who either exhibit two or

more cardiac risk factors or have a history of ischemic heart disease.

These recommendations were developed during a 2-day conference on

cardiac disorders and commercial drivers at the American College of

Cardiology in Bethesda, Maryland in 1986. The conference was convened

to assist the FHWA in developing a systematic and scientific basis for

updating the cardiac standards for commercial drivers. The final report

published in 1988 provided very specific recommendations for qualifying

drivers with cardiovascular conditions and for screening drivers for

cardiac risk factors. This cardiac conference guidance has been

extensively peer reviewed and is being updated as necessary. A copy of

this cardiac conference guidance is contained in the docket for public

inspection.

A full page of the proposed form is devoted to instruction and

recordation of the medical examiner's findings. The medical certificate

is also provided, and must be completed by the medical examiner if he

or she finds that the driver meets all the Federal physical

qualification requirements.

The third section of the proposed form not only sets forth the

Federal physical qualification standards found at 49 CFR 391.41, but

also contains more detailed information for the medical examiner

regarding the driver's role and the types of duties he or she may face

as a result of his or her employment. The FHWA believes that this

information is valuable to the medical examiner in making a

determination of physical qualification, and that such information may

not have been provided to medical examiners in the past because it was

not included on the current medical examination form. This section also

contains the FHWA's guidelines to help medical examiners assess a

driver's physical qualification. These guidelines are strictly advisory

and were established by the FHWA after consultation with physicians,

States, and industry representatives.

In addition to the revisions to 49 CFR 391.43 proposed in this

NPRM, the FHWA is making technical corrections to paragraphs (d) and

(g) of that section.

The FHWA's primary concern is to enhance safety on the Nation's

highways, not to unnecessarily limit the employment opportunities of

individuals with physical impairments. To the fullest extent possible,

consistent with its safety mandate and regulations, the FHWA is

interested in promoting individual determinations of medical

qualification to operate a CMV. The intent of this proposal is to

facilitate medical providers' efforts to establish, and document in a

clear and understandable way, the physical qualification of a driver to

operate a CMV.

Consequently, the FHWA requests comments from individuals, medical

providers, motor carriers, and all other interested parties on the

proposed medical examination form. The information should include, but

need not be limited to, information on how to improve the proposed

examination form and instructions for performing and recording physical

examinations.

Rulemaking Analyses and Notices

All comments received before the close of business on the comment

closing date indicated above will be considered and will be available

for examination in the docket room at the above address. Comments

received after the comment closing date will be filed in the docket and

will be considered to the extent practicable, but the FHWA may issue a

final rule at any time after the close of the comment period. In

addition to the late comments, the FHWA will also continue to file in

the docket relevant information that becomes available after the

comment closing date, and interested persons should continue to examine

the docket for new material.

Executive Order 12866 (Regulatory Planning and Review) and DOT

Regulatory Policies and Procedures

The FHWA has determined that the proposed action, if implemented,

would not be a significant regulatory action under Executive Order

12866 or significant under the regulatory policies and procedures of

the DOT. It is anticipated that the economic impact of this proposed

rule would be minimal because the use of existing printed supplies of

the forms addressed in this action will be allowed until the forms are

depleted, or until 12 months after the date of publication of this

rulemaking in the Federal Register, whichever occurs first. Allowing

the use of existing forms would avert substantial monetary loss by

motor carriers, medical providers, and vendors of forms that might

otherwise result from this rulemaking. Moreover, the proposed action

would facilitate regulatory uniformity and result in easier compliance

with and enforcement of the driver qualification requirements of the

FMCSRs. The proposed form would, to the extent possible, include all

relevant information necessary to establish and record the physical

qualification of a driver to operate a CMV. As a result, the FHWA

believes that this rulemaking would have a positive economic impact.

That is, time and cost burdens on truck and bus companies would not

increase and, indeed, such burdens on medical examiners could actually

decrease. Therefore, a full regulatory evaluation is not required.

Regulatory Flexibility Act

In compliance with the Regulatory Flexibility Act, 5 U.S.C. 601-

612, the FHWA is evaluating the effects of this proposal on small

entities. The FHWA believes that this proposed action, if implemented,

would not have a significant economic impact on a substantial number of

small entities or the nation's economy because it would allow

individual small carriers, medical providers and vendors of the form to

use the forms they now have on hand until those supplies have been

depleted, or until 12 months after the date of publication of this

rulemaking in the Federal Register. To the extent that the proposed

revised form would facilitate compliance with driver qualification

requirements, the projected positive economic impact is not expected to

be sufficiently significant to warrant a full regulatory evaluation.

The FHWA intends to further evaluate the economic consequences of this

proposal on small entities, however, in light of the

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comments received in response to this notice of proposed rulemaking.

Unfunded Mandates Reform Act of 1995

The FHWA will analyze any proposed rule to determine whether it

would result in the expenditure by State, local, and tribal

governments, in the aggregate, or by the private sector, of $100

million or more in any one year, as required by the Unfunded Mandates

Reform Act of 1995 (2 U.S.C. 1532).

Executive Order 12612 (Federalism Assessment)

This proposed rulemaking, if promulgated, would amend Part 391 of

the FMCSRs (Title 49, Code of Federal Regulations) pertaining to the

physical qualification and examination of drivers. This proposal has

been analyzed in accordance with the principles and criteria contained

in Executive Order 12612. Nothing in this proposal would preempt any

State law or regulation. This proposal would not limit the policy

making discretion of the States. Therefore, the FHWA has determined

that this proposal does not have sufficient federalism implications to

warrant the preparation of a separate Federalism Assessment.

Executive Order 12372 (Intergovernmental Review)

Catalog of Federal Domestic Assistance Program Number 20.217, Motor

Carrier Safety. The regulations implementing Executive Order 12372

regarding intergovernmental consultation on Federal programs and

activities do not apply to this program.

National Environmental Policy Act

The agency has analyzed this action for the purposes of the

National Environmental Policy Act of 1969, as amended (42 U.S.C. 4321

et seq.), and has determined that this action will not have any effect

on the quality of the environment.

Paperwork Reduction Act

The information collection requirements that would be imposed as a

result of this rulemaking are being submitted to the OMB for approval

in accordance with the Paperwork Reduction Act of 1995, 44 U.S.C. 3501-

3520. This rulemaking proposes a revision of a form used to collect

medical information about drivers of commercial motor vehicles (CMVs).

Title: Medical Qualifications Requirements.

Affected Public: Approximately 400,000 motor carriers and 500,000

medical examiners.

Abstract: Medical examiners are required to perform examinations of

CMV drivers who operate in interstate commerce. The results must be

recorded substantially in accordance with the instructions and the form

found at 49 CFR 391.43. Medical examiners are also required to fill out

a medical certificate upon completing an examination. The certificate

affirms that the driver is medically qualified to drive a CMV in

interstate commerce.

Under 49 CFR 391.51 and 398.3, motor carriers are required to

retain the medical examiner's certificate in the driver's qualification

file for 3 years.

Need: To ensure that only physically qualified CMV drivers operate

in interstate commerce.

Requested Time Period of Approval: The information collection for

this item, OMB Control Number, 2125-0080, was last approved by OMB on

September 2, 1997. It is valid through September 30, 2000.

Estimated Annual Burden: Based on an estimate of 5,500,000

interstate CMV drivers, the annual time burden upon medical examiners

and motor carriers for examinations and recordkeeping would be

approximately 412,500 hours. This is a decrease of 46,605 hours from

the burden under the previous form.

Comments are invited on any aspect of the proposed collection of

information, including but not limited to: (1) The necessity and

utility of the information collection for the proper performance of the

functions of the FHWA; (2) the accuracy of the estimated burden; (3)

ways to enhance the quality, utility, and clarity of the collected

information; and (4) ways to minimize the collection burden without

reducing the quality of the collected information.

Regulation Identification Number

A regulation identification number (RIN) is assigned to each

regulatory action listed in the Unified Agenda of Federal Regulations.

The Regulatory Information Service Center publishes the Unified Agenda

in April and October of each year. The RIN contained in the heading of

this document can be used to cross reference this action with the

Unified Agenda.

List of Subjects in 49 CFR Part 391

Driver qualifications--physical examinations, Highway safety, Motor

carriers, Reporting and recordkeeping requirements, Safety,

Transportation.

Issued: July 29, 1998.

Kenneth R. Wykle,

Federal Highway Administrator.

In consideration of the foregoing, the FHWA proposes to amend title

49, CFR, chapter III, part 391 as follows:

PART 391--QUALIFICATIONS OF DRIVERS [REVISED]

1. The authority citation for part 391 continues to read as

follows:

Authority: 49 U.S.C. 504, 31133, 31136, and 31502; and 49 CFR

1.48.

2. Section 391.43 is amended in paragraphs (d), (f), (g), and (h),

to read as follows:

Sec. 391.43 Medical examination; certificate of physical

qualification.

* * * * *

(d) Any driver authorized to operate a commercial motor vehicle

within an exempt intracity zone pursuant to Sec. 391.62 of this part

shall furnish the examining medical examiner with a copy of the medical

findings that led to the issuance of the first certificate of medical

examination which allowed the driver to operate a commercial motor

vehicle wholly within an exempt intracity zone.

(e) * * *

(f) The medical examination shall be performed, and its results

shall be recorded, substantially in accordance with the following

instructions and examination form. Existing forms may be used until

current printed supplies are depleted or until (Insert date 12 months

after the date of publication in the Federal Register), whichever

occurs first.

INSTRUCTIONS FOR PERFORMING AND RECORDING PHYSICAL EXAMINATIONS

The medical examiner must be familiar with 49 CFR 391.41,

Physical qualifications for drivers, and should review these

instructions before performing the physical examination. Answer each

question ``yes'' or ``no'' and record numerical readings where

indicated on the physical examination form.

The medical examiner must be aware of the rigorous physical,

mental, and emotional demands placed on the driver of a commercial

motor vehicle. In the interest of public safety, the medical

examiner is required to certify that the driver does not have any

physical, mental, or organic condition that might affect the

driver's ability to operate a commercial motor vehicle safely.

General information. The purpose of this history and physical

examination is to detect the presence of physical, mental, or

organic conditions of such a character and extent as to affect the

driver's ability to operate a commercial motor vehicle safely. The

examination should be conducted carefully and should at least

include all of the information requested in the following form.

History of certain conditions may be cause for rejection, indicate

the need for further testing, and/or require evaluation by a

specialist. Conditions may be recorded which do not, because of

their character or degree, indicate that certification of physical

fitness should be denied. However, these conditions should be

discussed with the driver and he/she should be advised to take the

necessary

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steps to insure correction, particularly of those conditions which,

if neglected, might affect the driver's ability to drive safely.

General appearance and development. Note marked overweight. Note

any postural defect, perceptible limp, tremor, or other conditions

that might be caused by alcoholism, thyroid intoxication or other

illnesses.

Head-eyes. When other than the Snellen chart is used, the

results of such test must be expressed in values comparable to the

standard Snellen test. If the driver wears corrective lenses for

driving, these should be worn while driver's visual acuity is being

tested. If appropriate, indicate the driver's need to wear

corrective lenses to meet the vision standard on the Medical

Examiner's Certificate by checking the box, ``Qualified only when

wearing corrective lenses.'' In recording distance vision use 20

feet as normal. Report all vision as a fraction with 20 as the

numerator and the smallest type read at 20 feet as the denominator.

Monocular drivers are not qualified to operate commercial motor

vehicles in interstate commerce. The use of contact lenses should be

noted on the form and there should be sufficient evidence of good

tolerance of and adaptation to their use.

Ears. Note evidence of any ear disease, symptoms of aural

vertigo, or Meuniere's Syndrome. When recording hearing, record

distance from patient at which a forced whispered voice can first be

heard. For the whispered voice test, the individual should be

stationed at least 5 feet from the examiner with the ear being

tested turned toward the examiner. The other ear is covered. Using

the breath which remains after a normal expiration, the examiner

whispers words or random numbers such as 66, 18, 23, etc. The

examiner should not use only sibilants (s-sounding test materials).

The opposite ear should be tested in the same manner. If the

individual fails the whispered voice test, the audiometric test

should be administered. For the audiometric test, record decibel

loss at 500 Hz, 1,000 Hz, and 2,000 Hz. Average the decibel loss at

500 Hz, 1,000 Hz and 2,000 Hz and record as described on the form.

If the individual fails the audiometric test and the whispered voice

test has not been administered, the whispered voice test should be

performed to determine if the standard applicable to that test can

be met.

Throat. Note any irremediable deformities likely to interfere

with breathing or swallowing.

Heart. Note murmurs and arrhythmias, and any history of an

enlarged heart, congestive heart failure, or cardiovascular disease

that is accompanied by syncope, dyspnea, or collapse. Indicate onset

date, diagnosis, medication, and any current limitation. An

electrocardiogram (ECG), exercise stress test (EST) and other tests

are required when findings so indicate. It is recommended that a

baseline ECG be done at age 40, then every 6 years until age 55,

then every 2 years thereafter, and an EST be done at age 45 if the

individual manifests one or more cardiac risk factors or has a

history of ischemic heart disease.

Blood pressure(BP). If a driver has hypertension and/or is being

medicated for hypertension, he or she should be recertified more

frequently. An individual diagnosed with mild hypertension (initial

BP is greater than 160/90 but below 181/105) should be certified for

one 3-month period and should be recertified on an annual basis

thereafter if his or her BP is reduced. An individual diagnosed with

moderate to severe hypertension (initial BP is greater than 180/104)

should not be certified until the BP has been reduced to the mild

range (below 181/105). At that time, a 3-month certification can be

issued. Once the driver has reduced his or her BP to below 161/91,

he or she should be recertified every 6 months thereafter.

Lungs. Note abnormal chest wall expansion, respiratory rate,

breath sounds including wheezes or alveolar rales, impaired

respiratory function, dyspnea, or cyanosis. Abnormal finds on

physical exam may require further testing such as pulmonary tests

and/or x-ray of chest.

Abdomen and Viscera. Note enlarged liver, enlarged spleen,

abnormal masses, bruits, hernia, and significant abdominal wall

muscle weakness and tenderness. If the diagnosis suggests that the

condition might interfere with the control and safe operation of a

commercial motor vehicle, further testing and evaluation is

required.

Genital-urinary and rectal examination. A urinalysis is

required. Protein, blood or sugar in the urine may be an indication

for further testing to rule out any underlying medical problems.

Note hernias or severe hemorrhoids. A condition causing discomfort

should be evaluated to determine the extent to which the condition

might interfere with the control and safe operation of a commercial

motor vehicle.

Neurological. Note impaired equilibrium, coordination, or speech

pattern; paresthesia; asymmetric deep tendon reflexes; sensory or

positional abnormalities; abnormal patellar and Babinski's reflexes;

ataxia. Abnormal neurological responses may be an indication for

further testing to rule out an underlying medical condition. Any

neurological condition should be evaluated for the nature and

severity of the condition, the degree of limitation present, the

likelihood of progressive limitation, and the potential for sudden

incapacitation. In instances where the medical examiner has

determined that more frequent monitoring of a condition is

appropriate, a certificate for a shorter period should be issued.

Spine, musculoskeletal. Previous surgery, deformities,

limitation of motion, and tenderness should be noted. Findings may

indicate additional testing and evaluation should be conducted.

Extremities. Carefully examine upper and lower extremities and

note any loss or impairment of leg, foot, toe, arm, hand, or finger.

Note any deformities, atrophy, paralysis, partial paralysis,

clubbing, edema, or hypotonia. If a hand or finger deformity exists,

determine whether prehension and power grasp are sufficient to

enable the driver to maintain steering wheel grip and to control

other vehicle equipment during routine and emergency driving

operations. If a foot or leg deformity exists, determine whether

sufficient mobility and strength exist to enable the driver to

operate pedals properly. In the case of any loss or impairment to an

extremity which may interfere with the driver's ability to operate a

commercial motor vehicle safely, the medical examiner should state

on the medical certificate ``medically unqualified unless

accompanied by a limb waiver.'' The driver must then apply to the

Regional Director of Motor Carriers, in the region in which the

driver has legal residence, for a limb waiver under Sec. 391.49.

Laboratory and Other Testing. Other test(s) may be indicated

based upon the medical history or findings of the physical

examination.

Diabetes. If insulin is necessary to control a diabetic driver's

condition, the driver is not qualified to operate a commercial motor

vehicle in interstate commerce. If mild diabetes is present and it

is controlled by use of an oral hypoglycemic drug and/or diet and

exercise, it should not be considered disqualifying. However, the

driver must remain under adequate medical supervision.

Upon completion of the examination, the medical examiner must date

and sign the form, provide his/her full name, office address and

telephone number. The completed medical examination form shall be

retained on file at the office of the medical examiner.

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(g) If the medical examiner finds that the person he/she examined

is physically qualified to drive a commercial motor vehicle in

accordance with Sec. 391.41(b), the medical examiner shall complete a

certificate in the form prescribed in paragraph (h) of this section and

furnish one copy to the person who was examined and one copy to the

motor carrier that employs him/her.

(h) The medical examiner's certificate shall be substantially in

accordance with the following form. Existing forms may be used until

current printed supplies are depleted or until (insert date 12 months

after the date of publication in the Federal Register), whichever

occurs first.

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[FR Doc. 98-20919 Filed 8-4-98; 8:45 am]

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