Medical Exam Checklist Part: 2

Checklist

This week, the FMCSA passed its last hurdle before publishing its list of Certified Medical Examiners. Read Part: 2 of the Medical Examiner’s Handbook to learn what the medical examiners will be expected to look for.

The following is taken from the FMCSA Medical Examiner’s Handbook:

Certification Status: Document the certification decision in the space provided for certification status. There are two possible outcomes: the driver is certified and issued a medical examiner’s certificate or the driver is disqualified and is not issued a medical examiner’s certificate.

  • Certify the driver
    • The driver meets all the standards ” The maximum length of time a driver can be medically certified is 2 years. The driver who must wear corrective lenses, a hearing aid, or have a Skill Performance Evaluation certificate may be certified for up to 2 years when there are no other conditions that require periodic monitoring.
    • The driver meets the standards but has a condition that requires frequent monitoring (and certification) ” Certify for less than 2 years as needed to monitor continued medical fitness for duty. Federal exemptions and some Federal Motor Carrier Safety Administration guidelines specify annual medical examinations.
  • Disqualify the driver
    • The driver does not meet the standards ” Do not issue a medical examiner’s certificate.
    • Discuss the disqualification decision with the driver, including what the driver can do to meet the Federal qualification requirements for commercial drivers.

Certification and recertification occur only when the medical examiner determines that the driver is medically fit for duty in accordance with Federal qualification requirements for commercial drivers.

Blood Pressure Pulse Rate:

Blood Pressure (BP)

  • Only BP readings taken during the driver physical or follow-up examinations may be used for certification decisions.
  • BP greater than 139/89 must be confirmed with a second measurement taken later during the examination.
  • Pulse
  • Document pulse rhythm by marking the Regular or Irregular box.
  • Record pulse rate.
  • Record additional pulse characteristics in your comments on the Medical Examination Report form.
 Column one has the blood pressure readings, and column two has the category classification.
ReadingCategory
140-159/90-99Stage 1 hypertension
160-179/100-109Stage 2 hypertension
greater than or equal to 180/110Stage 3 hypertension

When a BP reading is a value where the individual systolic and diastolic readings are in different stages, you should classify the reading by the higher stage. For example, 168/94 and 148/104 are both examples of Stage 2 hypertension.

Expiration DateRecertification
1 year1 year if less than or equal to 140/90
One-time certificate for 3 months1 year from date of examination if less than or equal to 140/90
6 months from date of examination if less than or equal to 140/906 months if less than or equal to 140/90

A driver with Stage 3 hypertension (greater than or equal to 180/110) is at an unacceptable risk for an acute hypertensive event and should be disqualified. You may reconsider the driver for certification following effective treatment for hypertension evidenced by BP stabilized at less than or equal to 140/90.

Pathology:

You must perform a urinalysis (dip stick)

Test for:

  • Specific gravity.
  • Protein (proteinuria).
  • Blood (hematuria).
  • Glucose (glycosuria).

Examine the eyes for:

  • Pupillary equality.
  • Reaction to light and accommodation.
  • Ocular motility.
  • Ocular muscle imbalance.
  • Extraocular movements.
  • Nystagmus.
  • Exophthalmos.

Ask about:

The hearing qualification requirement for:

  • Forced whisper test
    • First perceives a forced whispered voice.
    • In one ear.
    • At not less than five feet.
  • Audiometric test
    • Has an average hearing loss (average of test results for 500 hertz (Hz), 1,000 Hz, and 2,000 Hz).
    • In one ear.
    • Less than or equal to 40 dB.

Examine the ears for:

  • Scarring of the tympanic membranes.
  • Occlusion of the external ear canal.
  • Perforated eardrums.

To read an overview of the exam, read Part: 1 of the Medical Examiner’s Handbook.