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    **Email:**FMCSAMedical@dot.gov**Phone:** (202) 366-4001**Business Hours:**9:00am-5:00pm ET, M-F
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                Medical Regulations and Guidance Resource Links
    

    
    
    
      About the Tables

This document provides quick access through links to the Federal Motor Carrier Safety Regulations relevant to the physical qualification of interstate commercial motor vehicle (CMV) drivers as well as other available resources including Medical Review Board taskings and recommendations, and evidence reports.

Regulations vs. Guidance

Established under the Agency’s statutory authority, FMCSA’s safety regulations concerning the physical qualifications of drivers are legally binding on those subject to their provisions.  FMCSA has the authority to compel compliance with regulations.  These regulations ensure uniform application of the law and how the laws must be followed.

In addition, FMCSA provides medical guidance to Medical Examiners (MEs) in the form of advisory criteria, bulletins, interpretations of the regulations, and guidelines.  Medical guidance assists MEs in applying the regulations governing the physical qualifications of interstate CMV drivers.  Often, this guidance is based on input from medical expert panels or is derived from clinical best practices.  Unlike regulations, recommendations and other guidance do not have the force and effect of law and are not meant to bind the public in any way.  Rather, such guidance is strictly advisory, not mandatory, and intended solely to clarify existing requirements under the regulations or FMCSA policies.  The public (including MEs) is free to choose whether or not to utilize such guidance or recommendations as a basis for decision-making.

            Expand All
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        **Federal Motor Carrier Safety Regulations**
        The links below include sections from the Federal Motor Carrier Safety Regulations (FMCSRs) that are applicable to the physical qualification of interstate commercial motor vehicle (CMV) drivers.

**Title**
			**Citation**
			**Description****National Registry of Certified Medical Examiners******Scope.
			49 CFR 390.101
			Overview of 49 CFR 390.101-115.Eligibility requirements for medical examiner certification.
			49 CFR 390.103
			Provides requirements for becoming a certified medical examiner on the National Registry.Medical examiner training programs.
			49 CFR 390.105
			Provides requirements for training organizations and lists the core curriculum.Medical examiner certification testing.
			49 CFR 390.107
			Provides the criteria that testing organizations must meet.Issuance of the FMCSA medical examiner certification credential.
			49 CFR 390.109
			Describes when a medical examiner will receive certification, and the length of certification.Requirements for continued listing on the National Registry of Certified Medical Examiners.
			49 CFR 390.111
			Provides requirements for medical examiners to maintain their certification and listing on the National Registry.Reasons for removal from the National Registry of Certified Medical Examiners.
			49 CFR 390.113
			Provides reasons a medical examiner may be removed from the National Registry.Procedure for removal from the National Registry of Certified Medical Examiners.
			49 CFR 390.115
			Describes the methods of removal from the National Registry, and the accompanying process for each method.**Medical Examiner Certification Requirements for Qualified********Department of Veterans Affairs Examiners******Medical examiner certification for qualified Department of Veterans Affairs examiners.
			49 CFR 390.123
			Provides requirements for becoming a certified Veteran Affairs (VA) medical examiner on the National Registry.Qualified VA examiner certification training.
			49 CFR 390.125
			Provides requirements for qualified VA examiner certification training.Qualified VA examiner certification testing.
			49 CFR 390.127
			Provides requirements for qualified VA examiner certification testing.Issuance of the FMCSA medical examiner certification credential.
			49 CFR 390.129
			Describes when a VA medical examiner will receive certification, and the length of certification.Requirements for continued listing of a certified VA medical examiner on the National Registry of Certified Medical Examiners.
			49 CFR 390.131
			Provides requirements for VA medical examiners to maintain their certification and listing on the National Registry.Reasons for removal of a certified VA medical examiner from the National Registry of Certified Medical Examiners.
			49 CFR 390.133
			Provides reasons a VA medical examiner may be removed from the National Registry.Procedure for removal of a certified VA medical examiner from the National Registry of Certified Medical Examiners.
			49 CFR 390.135
			Describes the methods of a VA medical examiner removal from the National Registry, and the accompanying process for each method.**Physical Qualifications and Examinations******Physical qualifications for drivers.
			49 CFR 391.41
			States which drivers must carry a medical certificate, and sets out the physical qualification standards.Medical examination; certificate of physical examination.
			49 CFR 391.43
			States who may conduct examinations, which forms must be used to record results, how long to retain forms, and when to report to FMCSA.Persons who must be medically examined and certified.
			49 CFR 391.45
			States who must be examined by a certified medical examiner listed on the National Registry.Physical qualification standards for an individual with diabetes mellitus treated with insulin for control.
			49 CFR 391.46
			Provides the requirements for drivers with diabetes mellitus who are treated with insulin for control.Resolution of conflicts of medical evaluation.
			49 CFR 391.47
			Provides the requirements to apply for resolution of a conflict between a driver’s and motor carrier’s medical examiners.Alternative physical qualification standards for the loss or impairment of limbs.
			49 CFR 391.49
			Provides the requirements for drivers seeking a Skill Performance Evaluation (SPE) Certificate, and that drivers with an SPE Certificate may be medically qualified.**Limited Exemptions******Limited exemptions for intra-city zone drivers.
			49 CFR 391.62
			Provides the requirements for drivers to be exempted from the age restriction and certain physical standards.
  


      **Guidance**
        The links below are provided as a resource for information sharing and do not constitute regulatory standards; rather, they provide the ME medical information to consider when making a physical qualification determination.

The evidence reports included in the links below reflect the views of the authors, who are responsible for the facts and accuracy of the data presented at the time the expert reports were originally released.  The contents do not reflect the official policy of FMCSA.

Title
			Topic
			Date
			DescriptionMedical Advisory CriteriaMRB Task 16-02 Letter Report
			Medical Advisory Criteria
			December 13, 2016
			Medical Review Board’s (MRB) recommended revisions to the Medical Advisory Criteria.Appendix A to Part 391--Medical Advisory Criteria
			Medical Advisory Criteria
			January 19, 2024
			Published as an appendix to part 391 of the CFR, contains non-regulatory guidance to assist medical examiners.Medical Examiner's Handbook 2024 EditionMedical Examiner's Handbook 2024 Edition
			Medical Guidance
			January 22, 2024
			The Medical Examiner's Handbook provides information about regulatory requirements and guidance to medical examiners listed on FMCSA's National Registry of Certified Medical Examiners who perform physical qualification examinations of interstate commercial motor vehicle drivers.Sleep DisordersFinal MRB Task 16-01 Letter Report from Motor Carrier Safety Advisory Committee (MCSAC) and MRB
			Sleep Disorders
			November 21, 2016
			MRB recommendations regarding comments received on Advanced Notice of Proposed Rulemaking (ANPRM) on obstructive sleep apnea.MRB Task 16-01 Draft Letter Report
			Sleep Disorders
			August 26, 2016
			MRB recommendations to the ANPRM on obstructive sleep apnea.Draft Task 16-01 Discussion Notes
			Sleep Disorders
			August 23, 2016
			Draft discussion notes and MRB recommendations on obstructive sleep apnea.Obstructive Sleep Apnea and Commercial Motor Vehicle Driver Safety: Updated Review
			Sleep Disorders
			November 30, 2011
			Evidence report synthesizing research conducted since the 2007 evidence report on obstructive sleep apnea.Obstructive Sleep Apnea and Commercial Motor Vehicle Driver Safety
			Sleep Disorders
			November 21, 2007
			Evidence report presenting findings regarding obstructive sleep apnea and commercial drivers.Medication/Drug UseMRB Discussion on U.S. Food and Drug Administration (FDA) Warnings on Narcotics and Benzodiazepines and Incorporation Into Medical Examiner Forms
			Medication/Drug Use
			October 25, 2016
			MRB discussion notes and recommendations regarding FDA warnings on narcotics and benzodiazepines.Federal Register Notice on 391.41 CMV Driver Medication Form, MCSA-5895
			Medication/Drug Use
			July 8, 2016
			Federal Register notice announcing the 391.41 CMV Driver Medication Form, MCSA-5895.MRB and MCSAC Joint Task 14-3: Schedule II Controlled Substances and CMV Drivers
			Medication/Drug Use
			December 16, 2014
			Final revised MRB recommendations on Schedule II substances and commercial drivers.MRB Task 13-01:  Schedule II Controlled Substances and Commercial Motor Vehicle Drivers
			Medication/Drug Use
			October 13, 2014
			Draft revisions to MRB recommendations on Schedule II controlled substances and commercial drivers.MRB Task 13-1 Recommendations
			Medication/Drug Use
			October 22, 2013
			MRB recommendations on Schedule II substances and commercial drivers.Licit Schedule II Drug Use and Commercial Motor Vehicle Driver Safety
			Medication/Drug Use
			October 21, 2006
			Evidence report presenting findings regarding medication/drug use and commercial drivers.Public-Private PartnershipsMCSAC Task 15-3:  Recommendations to the Agency on the Structure, Content, and Methods for Determining the Effectiveness of a Public-Private Partnership to Promote CMV Driver Wellness
			Public-Private Partnerships
			August 10, 2016
			MCSAC draft discussion notes and recommendations on public-private partnership activities.MCSAC and MRB Task 15-3:  Recommendations to the Agency on the Structure, Content, and Methods for Determining the Effectiveness of a Public-Private Partnership to Promote CMV Driver Wellness
			Public-Private Partnerships
			September 21-22, 2015
			MCSAC and MRB draft discussion notes and recommendations on public-private partnerships.DiabetesMRB Task 21-2:  Draft MRB Recommendations to the Agency regarding the proposed Non-Insulin-Treated Diabetes Mellitus Assessment Form
			Diabetes
			May 19-20, 2021
			Draft MRB recommendations regarding the proposed Non-Insulin-Treated Diabetes Mellitus Assessment FormMRB Task 15-1: Recommendations on the Disposition of Public Comments from Medical Professionals and Associations to FMCSA’s Notice of Proposed Rulemaking (NPRM) on Insulin-Dependent Drivers of Commercial Motor Vehicles (CMVs) with Diabetes Mellitus
			Diabetes
			September 1, 2015
			MRB recommendations regarding comments on the Notice of Proposed Rulemaking (NPRM) on insulin-treated drivers of commercial motor vehicles with diabetes mellitus.Diabetes and Commercial Motor Vehicle Driver Safety
			Diabetes
			May 27, 2011
			Evidence report with updated information regarding diabetes and commercial drivers.Diabetes and Commercial Motor Vehicle Driver Safety
			Diabetes
			September 8, 2006
			Evidence report presenting findings regarding diabetes and commercial drivers.VisionMRB Task 21-1:  MRB Recommendations to the Agency regarding the Proposed Alternative Vision Standard and Vision Evaluation Report Form
			Vision
			May 19-20, 2021
			MRB recommendations regarding proposed alternative vision standard and Vision Evaluation Report Form.MRB Task 15-2: Recommendations on Potential Regulatory Actions Concerning Vision Standards for Interstate CMV Drivers
			Vision
			September 1, 2015
			MRB recommendations on FMCSA’s vision standards for CMV drivers.Vision and Commercial Motor Vehicle Driver Safety
			Vision
			June 6, 2008
			Evidence report presenting findings regarding vision and commercial drivers.HearingCochlear Implants and Commercial Motor Vehicle Driver Safety
			Hearing
			October 29, 2010

			Revised January 14, 2011
			Targeted evidence report presenting findings regarding cochlear implants and commercial drivers.Hearing, Vestibular Function, and Commercial Driver Safety
			Hearing
			August 26, 2008
			Evidence report presenting findings regarding hearing and vestibular disorders and commercial drivers.Traumatic Brain InjuryTraumatic Brain Injury and Commercial Motor Vehicle Driver Safety
			Traumatic Brain Injury
			March 30, 2009
			Draft evidence report presenting findings regarding traumatic brain injury and commercial drivers.StrokeStroke and Commercial Motor Vehicle Driver Safety
			Stroke
			September 15, 2008
			Executive summary to evidence report presenting findings regarding stroke and commercial drivers.Psychiatric DisordersPsychiatric Disorders and Commercial Motor Vehicle Driver Safety
			Psychiatric Disorders
			August 29, 2008
			Evidence report presenting findings regarding psychiatric disorders and commercial drivers.Movement DisordersParkinson’s Disease, Multiple Sclerosis, and Commercial Motor Vehicle Driver Safety
			Movement Disorders
			June 3, 2009
			Evidence report presenting findings regarding Parkinson’s disease, multiple sclerosis, and commercial drivers.Musculoskeletal DisordersMusculoskeletal Disorders and Commercial Motor Vehicle Driver Safety
			Musculoskeletal Disorders
			May 29, 2009
			Evidence report presenting findings regarding musculoskeletal disorders and commercial drivers.SeizuresSeizure Disorder and Medical Certification of Commercial Motor Vehicle Driver Safety (2019)
			Seizures
			March 2019
			Update to 2007 evidence report presenting findings regarding seizures and commercial drivers.Seizure Disorders and Commercial Motor Vehicle Driver Safety
			Seizures
			November 30, 2007
			Evidence report presenting findings regarding seizures and commercial drivers.Expert Panel Recommendations – seizure disorders
			
			October 15, 2007
			Expert panel recommendations regarding seizure disorders and commercial driver safetyKidney DiseaseChronic Kidney Disease and Commercial Motor Vehicle Driver Safety
			Kidney Disease
			November 5, 2007
			Evidence report presenting findings regarding kidney disease and commercial drivers.Cardiovascular DiseaseResearch White Paper - Implantable Cardio Defibrillators and the Impact of a Shock to the Patient when Deployed
			ICD
			December 17, 2014
			White paper regarding research on implantable cardio defibrillators and the impact of a shock to the patient when deployed.Expert Panel Recommendations – Cardiovascular disease
			Cardiovascular Disease
			June 5, 2013
			Expert Panel Recommendations - Medical Examiner Physical Qualification Standards and Clinical Guidelines for Cardiovascular Disease and Commercial Motor Vehicle Driver SafetyCardiovascular Disease and Commercial Motor Vehicle Driver Safety
			Cardiovascular Disease
			April 27, 2007
			Evidence report presenting findings regarding cardiovascular disease and commercial drivers.**Skill Performance Evaluation (SPE) Certificate**Krusen Study on Limb Prosthetics
			SPE
			April 1977
			Study regarding limb prosthetics for the SPE certificate program.**FMCSA Research Projects**Research Brief - Examining the Seizure Standard for Commercial Motor Vehicle Drivers
			Seizure
			June 1, 2023
			Research brief regarding the study on the seizure standard.Examining the Seizure Standard for Commercial Motor Vehicle Drivers
			Seizure
			June 1, 2023
			Evidence Reports, Systematic Review, and Medical Expert Panel Report regarding the seizure standard.Effect of the Length of Medical Certification on Safety
			Research
			February 1, 2023
			Study to evaluate the relationship between the duration of CMV drivers’ medical certification and crash and/or violation risk.
  


      **Medical Examination Forms**
        The links below are to each of the forms used during the physical qualification of interstate commercial motor vehicle (CMV) drivers examination.

**Form**
			**Description**Insulin-Treated Diabetes Mellitus Assessment Form, MCSA-5870
			This form is required to be completed for drivers who have insulin-treated diabetes mellitus by their treating clinician and must be evaluated under 49 CFR 391.46.Vision Evaluation Report Form, MCSA-5871
			This form is required to be completed for drivers who have monocular vision, as defined by FMCSA, or do not meet FMCSA's vision standard, by their ophthalmologist or optometrist.Non-Insulin-Treated Diabetes Mellitus Assessment Form, MCSA-5872 (optional)
			This optional form can be used to request additional information from a driver regarding their diagnosis, monitoring, and stability of non-insulin-treated diabetes mellitus to determine if the driver is medically qualified per 49 CFR 391.41.Medical Examination Report Form, MCSA-5875
			This form is required to record the results of the medical examination performed on each driver.Medical Examiner's Certificate, Form MCSA-5876
			This form is required to be completed if a driver is found to be medically qualified and should reflect the same qualification decision indicated on the Medical Examination Report Form, MCSA-5875.391.41 CMV Driver Medication Form, MCSA-5895 (optional)
			This optional form can be used to request additional information from a driver regarding their medications prescribed by their treating clinician for a medical examiner to use in determine if the driver is medically qualified per 49 CFR 391.41.

    
          Last updated: Tuesday, February 20, 2024 U.S. DEPARTMENT OF TRANSPORTATION

**Federal Motor Carrier Safety Administration**

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WASHINGTON, DC 20590

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