Code of Maine Rules › 29 - DEPARTMENT OF THE SECRETARY OF STATE › 250 - BUREAU OF MOTOR VEHICLES › Bureau of Motor Vehicles › Chapter 3 - PHYSICAL, EMOTIONAL AND MENTAL COMPETENCE TO OPERATE A MOTOR VEHICLE › Appendix - APPENDIX

Current through 2024-29, July 17, 2024
(Items included in the appendix are for information
					 only and are not incorporated into rules.)
BUREAU OF MOTOR VEHICLES - DRIVING TEST
Purpose of test
There are a wide variety of physical, emotional and mental
					 conditions that have the potential to impact an individual's ability to drive
					 safely. Impairment may be the result of altered muscular, skeletal, neurologic
					 or cognitive functions. Motor, sensory, and/or cognitive deficits may adversely
					 affect strength, coordination, reaction time, range of motion, visual
					 perception, processing speed, judgment, problem solving,
					 attention/concentration, memory, and/or awareness, to name a few. Some
					 impairment may require restrictions such as corrective lenses, or adaptive
					 equipment for the vehicle. Most people with these conditions may continue to
					 operate safely without restriction. In the most severe circumstances, a
					 person's condition may preclude driving. In certain situations, a driving test
					 will be required to determine whether or not a person is capable of properly
					 operating a motor vehicle. This is not a comprehensive medical evaluation. It
					 is a simple driving test to evaluate basic driving skills.
Components of driving test
Experience
Adjust to conditions
Familiar with vehicle
Proper control
Shifting
Select proper gear
Proper use of clutch
No stalling
Traffic Rules
Appropriate stops
Operate within own lane
Proper lane position
Proper operation at traffic signal
Signs/Signals
Stop at STOP sign
Stop at red light
Stop for stopped school bus
Turning
Left/Right
Approach from correct lane
Enter correct lane
No cutting corner
No wide approach at intersection
No wide entrance of lane at intersection
Proper recovery
Backing
Straight line back without going into traffic lane,
								onto sidewalk or curb
Offset back (parallel parking)
Look over shoulder
Look to rear
Signaling
Signal appropriately
Use correct signals
Posted Speed
Stay within posted speed limits
Pedestrians
Yield for pedestrians in crosswalk and
								roadway
Railroad Crossing
Obey signals
Observe both ways before crossing
Yielding
Yield properly
Other
Observe at intersections
Observe when changing lanes
Observe when pulling from curb
Collision
Avoid collision with another vehicle or any fixed
								object
(This information is included for information only
					 and is not incorporated into rules.)
DRIVING EVALUATIONS BY AN OCCUPATIONAL
					 THERAPIST
"Occupational therapy practitioners with specialized
					 training in driver rehabilitation may administer comprehensive driving
					 evaluations. This type of driving evaluation typically includes two parts: one
					 part in an office or clinic and the second part behind the wheel of a car. The
					 purpose of the evaluation in the office or clinic is to examine the physical,
					 visual, and mental abilities required for safe driving. This would
					 include:
Reaction time, needed for stopping fast enough to
						avoid a crash;
										Basic visual acuity, or sharpness of vision;
						and
										Decision making, judgment, and planning (e.g., needed
						for making left turns)."
Quotation from the American Occupational
					 Association website. For more information, please visit:
https://www.aota.org/practice/productive-aging/driving/clients/evaluate/eval-by-ot.aspx
(This information is included for information only
					 and is not incorporated into rules.)
POTENTIAL BIOMARKERS OF ALCOHOL USE
Note: Medical providers are strongly encouraged to read the
					 information in this reference to get more details about the appropriate use of
					 these lab tests. The tests are listed here as a basic introduction. Medical
					 providers need to understand the subtleties of these lab tests and the
					 potential for false positives and false negatives when using these tests
					 clinically.
Biomarker1
Screens for Heavy Drinking
Identifies Relapse to Heavy
								Drinking
Monitors Abstinence
Time to return to normal - Range with
								abstinence
CDT
yes
yes
2-3 weeks
Ethyl Glucuronide (urine)
yes
yes
1-3 days
EtS
yes
yes
1-3 days
GGT
yes
2-4 weeks
MCV
yes
several months
Phosphatidyl ethanol
yes
2-4 weeks
AST, ALT
yes
2-4 weeks
1
The role of Biomarkers
					 in the Treatment of Alcohol use Disorder, Revision Spring 2012. Volume 11,
					 Issue 2.
www.samhsa.gov
This reference is available free, online, and
					 isincluded for information only. It is not a part of rules.
SAMPLE BINOCULAR ESTERMAN TEST - 1
(Included for information only and not incorporated into
					 rules.)
Click to view
					 image
SAMPLE BINOCULAR ESTERMAN TEST - 2
(Included for information only and not incorporated into
					 rules.)
Click to view
					 image
BIBLIOGRAPHY
(References are included for information only and are
					 not a part of rules.)
CARDIOVASCULAR CONDITIONS
Epstein A.E. Miles W.M. Benditt D.G. et al. Personal and
					 public safety issues related to arrhythmias that may affect consciousness:
					 implications for regulation and physician recommendations. A medical/scientific
					 statement from the American Heart Association and the North American Society of
					 Pacing and Electrophysiology. Circulation. 1996; 94: 1147-1166
Shen WK, Sheldon RS, Benditt DG, et al. 2017 ACC/AHA/HRS
					 guideline for the evaluation and management of patients with syncope: a report
					 of the American College of Cardiology/American Heart Association Task Force on
					 Clinical Practice Guidelines and the Heart Rhythm Society[published online
					 March 9, 2017]. Heart Rhythm. doi:10.1016/j.hrthm.2017.03.004.
Tan VH, Ritchie D, Maxey C, Sheldon R; POST Investigators.
					 Prospective Assessment of the Risk of Vasovagal Syncope During Driving. JACC
					 Clin Electrophysiol. 2016 Apr;2(2):203-208. doi: 10.1016/j.jacep.2015.10.006.
					 Epub 2015 Nov 17. PMID: 29766871.
Sorajja D, Nesbitt GC, Hodge DO, Low PA, Hammill SC, Gersh
					 BJ, Shen WK. Syncope while driving: clinical characteristics, causes, and
					 prognosis. Circulation. 2009 Sep 15;120(11):928-34. doi:
					 10.1161/CIRCULATIONAHA.108.827626. Epub 2009 Aug 31. PMID: 19720940; PMCID:
					 PMC3918881.
https://www.gov.uk/guidance/cardiovascular-disorders-assessing-fitness-to-drive
Curtis, Anne B. When Is It Safe To Resume Driving After ICD
					 Implantation. American College of Cardiology: Expert Analysis. 2011 Sep 7.
https://www.acc.org/latest-in-cardiology/articles/2014/07/18/11/37/when-is-it-safe-to-resume-driving-after-icd-implantation
Margulescu AD, Anderson MH. A Review of Driving
					 Restrictions in Patients at Risk of Syncope and Cardiac Arrhythmias Associated
					 with Sudden Incapacity: Differing Global Approaches to Regulation and Risk.
					 Arrhythm Electrophysiol Rev. 2019 May;8(2):90-98. doi: 10.15420/aer.2019.13.2.
					 PMID: 31114682; PMCID: PMC6528027
CHRONIC RESPIRATORY DISEASE
A Grant, I., Heaton, R.K.,
					 McSweeny, A.J., Adams, K.M., & Timms, R.M. (1982). Neuropsychologic
					 findings in hyoxemic chronic obstructive pulmonary disease. Archives of
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B Prigatono, G.P., Parsons,
					 G.A., Wright, E., et al. (1983). Neuropsychologic test performance in mildly
					 hypoxemic patients with chronic obstructive pulmonary disease. Journal of
					 Clinical and Consulting Psychology, 51, 108-116.
C Grant, I., Prigatano, G.P.,
					 Heaton, R.K., McSweeny, A.J., Wright, E. C., & Adams, K.M. (1987).
					 Progressive neuropsychologic impairment and hypoxemia. Annals of General
					 Psychiatry, 44, 999-1006.
D Karakontaki, F., Gennimata,
					 S., et al. Driving-Related Neuropsychological Performance in Stable COPD
					 Patients(2013). Pulmonary Medicine, 2013, 1-10.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3575615/
E Orth, M., Diekmann, C., et al,
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F Diller, E., Cook, L., Leonard,
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DEMENTIA
A Driver Fitness Medical
					 Guidelines, September 2009, DOT HS 811 210; National Highway Traffic Safety
					 Administration.
www.nhtsa.gov
B Clinician's Guide To Assessing
					 and Counseling Older Drivers 4th Edition (2019)
https://geriatricscareonline.org/application/content/products/B047/pdf/AGS-Clinicians_Guide_4th_edition.pdf
C D.J. Iverson, G.S. Gronseth,
					 M.A. Reger, S. Classen, R.M. Dubinsky, M. Rizzo Practice Parameter update:
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					 (16) 1316-1324;
https://n.neurology.org/content/74/16/1316.short
D Ladden MD. Approach to the
					 evaluation of older drivers In: UpToDate, Schmader KE (Ed), UpToDate, Waltham,
					 MA. (Accessed July 17, 2020.)
HYPOGLYCEMIA
Medical Conditions and Driving - A Review of Literature
					 (1960-2000), September 2005, DOT HS 809 690; US Dept. of Transportation
					 National Highway Traffic Safety Administration
Assessing Fitness to Drive for Commercial and Private
					 Vehicle Drivers, Medical Standards to Drive and Clinical Management Guidelines,
					 2016 as amended up to August 1, 2017, NTC Australia Driver Fitness Medical
					 Guidelines, September 2009, DOT HS 811 210; National Highway Traffic Safety
					 Administration
www.nhtsa.gov
MENTAL HEALTH
A Medical Conditions and Driving
					 - A Review of Literature (1960-2000), September 2005, DOT HS 809 690; US Dept
					 of Transportation National Highway Traffic Safety Administration
https://icsw.nhtsa.gov/people/injury/research/Medical_Condition_Driving/pages/Sec1-Intro.htm
B Hartman RL, Huestis MA.
					 Cannabis effects on driving skills. Clin Chem. 2013;59(3):478-492.
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C Ramaekers, J. G., Berghaus,
					 G., van Laar, M., & Drummer, O. H. (2004). Dose related risk of motor
					 vehicle crashes after cannabis use. Drug and Alcohol Dependence, 73, 109-119.
					 doi:10.1016/j.drugalcdep.2003.10.008
DAsbridge, M., Hayden, J. A.,
					 & Cartwright, J. L. (2012). Acute cannabis consumption and motor vehicle
					 collision risk: Systematic review of observational studies and meta-analysis.
					 BMJ, 344, e536. doi:10.1136/bmj.e536.
E Li, M.-C., Brady, J. E.,
					 DiMaggio, C. J., Lusardi, A. R., Tzong, K. Y., & Li, G. (2012). Marijuana
					 use and motor vehicle crashes. Epidemiologic Reviews, 34, 65-72.
					 doi:10.1093/epirev/mxr017.
FMcCarthy, D. M., Lynch, A. M.,
					 & Pedersen, S. L. (2007). Driving after use of alcohol and marijuana in
					 college students. Psychology of Addictive Behaviors, 21(3), 425-430.
https://doi.org/10.1037/0893-164X.21.3.425
GAmerican Psychiatric
					 Association (2013). Diagnostic and Statistical Manual (5th ed). Washington DC.
HBenbadis, S, Lutsep, H, et al.
					 Psychogenic Nonepileptic Seizures. Medscape. Updated: July 26, 2018.
https://emedicine.medscape.com/article/1184694-overview
I Morrison I and Razvi S.
					 Driving regulations and psychogenic non-epileptic seizures: Perspectives from
					 the United Kingdom. Seizure European Journal of Epilepsy. March 2011.
					 20(2):177-180.
https://pubmed.ncbi.nlm.nih.gov/21112222/
J Rossi S, Hallett M, Rossini
					 Ret al. Safety, ethical considerations and application guidelines for the use
					 of transcranial magnetic stimulation in clinical practice and research. Clin
					 Neurophysiol 2009. 120(12):2008-2039.
https://pubmed.ncbi.nlm.nih.gov/19833552/
MUSCULOSKELETAL AND NEUROLOGICAL
Thompson, T., Poulter, D., Miles, C., Solmi, M., Veronese,
					 N., Carvalho, A. F., Stubbs, B., & Uc, E. Y. (2018). Driving impairment and
					 crash risk in Parkinson disease: A systematic review and meta-analysis.
					 Neurology, 91(10), e906-e916.
https://doi.org/10.1212/WNL.0000000000006132
Akinwuntan, A. E., O'Connor, C., McGonegal, E., Turchi, K.,
					 Smith, S., Williams, M., & Wachtel, J. (2012). Prediction of driving
					 ability in people with relapsing-remitting multiple sclerosis using the stroke
					 driver screening assessment. International journal of MS care, 14(2), 65-70.
https://doi.org/10.7224/1537-2073-14.2.65
Greve, J. M., Santos, L., Alonso, A. C., & Tate, D. G.
					 (2015). Driving evaluation methods for able-bodied persons and individuals with
					 lower extremity disabilities: a review of assessment modalities. Clinics (Sao
					 Paulo, Brazil), 70(9), 638-647.
https://doi.org/10.6061/clinics/2015(09)08
Morrow, S. A., Classen, S., Monahan, M., Danter, T.,
					 Taylor, R., Krasniuk, S., Rosehart, H., & He, W. (2018). On-road assessment
					 of fitness-to-drive in persons with MS with cognitive impairment: A prospective
					 study. Multiple Sclerosis Journal, 24(11), 1499-1506.
https://doi.org/10.1177/1352458517723991
Devos, H., Akinwuntan, A. E., Nieuwboer, A., Truijen, S.,
					 Tant, M., & De Weerdt, W. (2011). Screening for fitness to drive after
					 stroke: a systematic review and meta-analysis. Neurology, 76(8), 747-756.
https://doi.org/10.1212/WNL.0b013e31820d6300
Frith, J., Hubbard, I. J., James, C. L., &
					 Warren-Forward, H. (2015). Returning to driving after stroke: A systematic
					 review of adherence to guidelines and legislation. British Journal of
					 Occupational Therapy, 78(6), 349-355.
https://doi.org/10.1177/0308022614562795
NARCOLEPSY
A National Organization for Rare
					 Disorders, For Patients and Families, Rare Disease Information, Rare Disease
					 Information, Narcolepsy. Accessed: 02.03.2022.
https://rarediseases.org/rare-diseases/narcolepsy/
B T. Morgenthaler, V Kapur, T.
					 Brown, et al. Practice Parameters for the Treatment of Narcolepsy and other
					 Hypersomnias of Central Origin. Sleep, 2007, Dec 1; 30 (12): 1705-1711
C M. Littner, C. Kushida, M.
					 Wise, et al. Practice Parameters for Clinical Use of the Multiple Sleep Latency
					 Test and the Maintenance of Wakefulness Test. Sleep, 2005; 28
					 (1):113-121
D Aldrich, M.S. Automobile
					 accidents in patients with sleep disorders. Sleep 1989; 12(6), 487-494.
E Broughton R, Ghanem Q,
					 Hishikawa Y, Sugita Y, Nevsimalova S, Roth B. Life effects of narcolepsy in 180
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F Aldrich, M.S. Narcolepsy. The
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G Findley, L., Unverzagt, M.,
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					 108(3), 619-624
H Trotti LM. Arnulf I.
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I Maski K. Trotti, LM. Kotagal,
					 Suresh. Auger, RR. Rowley, J. Hashmi, SD. Watson, NF. Treatment of central
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K Review by the MSLT and MWT
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					 123-144.
OTHER MEDICAL
Clinician's Guide to Assessing and Counselling Older
					 Drivers, 4th Ed. (2019)
https://www.nhtsa.gov/document/clinicians-guide-assessing-and-counseling-older-drivers
PRESCRIPTION MEDICATIONS AND/OR OPIOID REPLACEMENT
					 THERAPY
A Soyka M et al. Less impairment
					 in one portion of a driving-relevant psychomotor battery in
					 buprenorphine-maintained than in methadone maintenance patients. Results of a
					 randomized clinical trial. J of Clin Psychopharm 2005; 25(5), 490-493
B National Highway Traffic
					 Safety Administration:
Drug and Human Performance Fact Sheets.
					 Methadone
.
http://www.nhtsa.gov/people/injury/research/job185drugs/methadone.htm
SEIZURES AND EPILEPSY
Driver Fitness Medical Guidelines, September 2009, DOT HS
					 811 210; National Highway Traffic Safety Administration.
www.nhtsa.gov
Krumholz, Allan, et al. Driving restrictions for patients
					 with seizures and epilepsy. In UpToDate, Garcia, P (Ed), UpToDate, Waltham,
					 Mass, (Accessed on June 14, 2021.)
SLEEP APNEA
A Gurubhagavatula
MD. Drowsy driving: Risks, evaluation, and management In: UpToDate,
					 Scammell TE (Ed), UpToDate, Waltham, MA. (Accessed March 30, 2021.)
https://www.uptodate.com/contents/drowsy-driving-risks-evaluation-and-management
B Vorona RD, Ware JC: Sleep
					 disordered breathing and driving risk. Curr Opin Pulm Med 2002; 8: 506-510
C Tregear,S Reston J, Phillips
					 B: Continuous positive airway pressure reduces risk of motor vehicle crash
					 among drivers with obstructive sleep apnea: systematic review and
					 meta-analysis. Sleep, 2010; 33(10): 1373-1380.
D Weaver TE, Mancini C, Maislin G,
					 Cater J, Staley B, Landis JR, Ferguson KA, George CF, Schulman DA, Greenberg H,
					 Rapoport DM, Walsleben JA, Continuous positive airway pressure treatment of
					 sleepy patients with milder obstructive sleep apnea: results of the CPAP Apnea
					 Trial North American Program (CATNAP) randomized clinical trial. AM J Resp
					 Critical Care Med, 2012 Oct 1;186(7):677-83.
E George CF: Reduction in motor
					 vehicle collisions following treatment of sleep apnea with nasal CPAP. Thorax
					 2001; 56:508-512
F Patil SP, Ayappa IA, Caples
					 SM, Kimoff RJ, Patel SR, Harrod CG. Treatment of adult obstructive sleep apnea
					 with positive airway pressure: an American Academy of Sleep Medicine systematic
					 review, meta-analysis, and GRADE assessment. J Clin Sleep Med.
					 2019;15(2):301-334.
G Sassani A, Findley LJ, Kryger
					 M, et al: Reducing motor vehicle collisions, costs, and fatalities by treating
					 obstructive sleep apnea. Sleep, 2004; 27(3): 453-458.
H Kryger M, Malhotra A.
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UpToDate, Waltham, MA. (Accessed February 3, 2022.)
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I Malhotra, Atul.
					 Hypoglossal-nerve stimulation for obstructive sleep apnea. N Engl J Med, 2014
					 Jan 9; 370(2):170-1
J Littner MR, Kushida C, Wise M,
					 Davila DG, Morgenthaler T, Lee-Chiong T, Hirshkowitz M, Daniel LL, Bailey D,
					 Berry RB, Kapen S, Kramer M; Standards of Practice Committee of the American
					 Academy of Sleep Medicine. Practice parameters for clinical use of the multiple
					 sleep latency test and the maintenance of wakefulness test. Sleep. 2005
					 Jan;28(1):113-21.
K Johns, Murray, The Epworth
					 Sleepiness Scale: About the ESS. (Accessed: February 3, 2022.)
https://epworthsleepinessscale.com/about-the-ess/
L Centers for Medicare and
					 Medicaid Services, SUPERSEDED Local Coverage Determination (LCD): Positive
					 Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea
					 (L33718). Accessed March 14, 2022. LCD - Positive Airway Pressure (PAP) Devices
					 for the Treatment of Obstructive Sleep Apnea (L33718) (cms.gov)
SUBSTANCE USE DISORDER
A Substance Abuse Trends in
					 Maine State Epidemiological Profile 2016.
https://www.maineseow.com/Documents/SEOW%20EpiProfile%202016%20FINAL.pdf
B Drug-Impaired Driving:
					 Marijuana and Opioids Raise Critical Issues for States. Governors Highway
					 Safety Association. May 2018, p. 7.
https://www.ghsa.org/sites/default/files/2018-05/GHSA_DrugImpairedDriving_FINAL.pdf
C NIH Drug Facts, December 2019
https://www.drugabuse.gov/sites/default/files/drugfacts-drugged-driving.pdf
D The Health Effects of Cannabis
					 and Cannabinoids: The Current State of Evidence and Recommendations for
					 Research. National Academy of Sciences (NAS). January 12, 2017
https://www.nap.edu/resource/24625/Cannabis_committee_conclusions.pdf
E
Azagba, et al.
					 Positive drug test trends in fatally injured drivers in the United States from
					 2007 to 2017. Substance Abuse Treatment, Prevention, and Policy (2019)
					 14:43.
https://substanceabusepolicy.biomedcentral.com/track/pdf/10.1186/s13011-019-0228-z
F American Psychiatric
					 Association (2013). Diagnostic and Statistical Manual (5th ed). Washington
					 DC.
G National Institute on Alcohol
					 Abuse and Alcoholism. Alcohol's Effects on Health: Overview of Alcohol
					 Consumption, Drinking Levels Defined. Accessed 02.08.2022.
https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking
H Driver Fitness Medical
					 Guidelines, September 2009, DOT HS 811 210; National Highway Traffic Safety
					 Administration.
www.nhtsa.gov
I Drug-Impaired Driving: A Guide
					 for States. Governors Highway Safety Association. April,2017, p. 2.
https://www.ghsa.org/sites/default/files/2017-04/GHSA_DruggedDriving2017_FINAL.pdf
J Brady JE, Li G., Trends in
					 Alcohol and Other Drugs Detected in Fatally Injured Drivers in the United
					 States. 1999-2010. Am J Epidemiology 2014; 179(6):692-9. Epub Jan 29, 2014: doi
					 10.1093/aje/kwt327
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3939850/pdf/kwt327.pdf
K The 2013-2014 National
					 Roadside Study of Alcohol and Drug Use.
https://www.nhtsa.gov/behavioral-research/2013-14-national-roadside-study-alcohol-and-drug-use-drivers#2013-14-national-roadside-study-alcohol-and-drug-use-drivers-2013-14-national-roadside-study-alcohol
L JA Ewing. Detecting
					 Alcoholism: The CAGE Questionnaire. JAMA 252: 1905-1907; 1984.
https://jamanetwork.com/journals/jama/fullarticle/182810
M Babor TF, et al. The Alcohol
					 Use Disorders Identification Test Guidelines for Use in Primary Care,
					 2nd Ed.
https://www.who.int/publications/i/item/audit-the-alcohol-use-disorders-identification-test-guidelines-for-use-in-primary-health-care
N Reisfield GM, Salazar E,
					 Bertholf RL. Review: Rational Use and Interpretation of Urine Drug Testing in
					 Chronic Opioid Therapy. An Clin Lab Sci Autumn 37(4), 301-314, 2007.
www.annclinlabsci.org/content/37/4/301.full
O The role of Biomarkers in the
					 Treatment of Alcohol use Disorder. Spring 2012. Volume 11, Issue 2.
https://etg.weebly.com/uploads/7/4/7/5/74751/samsha_biomarker_advisory_may_2012.pdf
UNEXPLAINED ALTERATION/LOSS OF
					 CONSCIOUSNESS
Weisberg, LA., Garcia, R Strub. "Episodic Loss of
					 Consciousness." Essentials of Clinical Neurology: Neurology History and
					 Examination. Chapter 8, pp. 1-13.
www.psychneuro.tulane.edu/neurolect/
https://n.neurology.org/content/48/1/299.2
Shen WK, Sheldon RS, Benditt DG, et al. 2017 ACC/AHA/HRS
					 guideline for the evaluation and management of patients with syncope: a report
					 of the American College of Cardiology/American Heart Association Task Force on
					 Clinical Practice Guidelines and the Heart Rhythm Society[published online
					 March 9, 2017]. Heart Rhythm. doi:10.1016/j.hrthm.2017.03.004.
Margulescu AD, Anderson MH. A Review of Driving
					 Restrictions in Patients at Risk of Syncope and Cardiac Arrhythmias Associated
					 with Sudden Incapacity: Differing Global Approaches to Regulation and Risk.
					 Arrhythm Electrophysiol Rev. 2019 May;8(2):90-98. doi: 10.15420/aer.2019.13.2.
					 PMID: 31114682; PMCID: PMC6528027.
Sorajja D, Nesbitt GC, Hodge DO, et al. Syncope While
					 Driving: Clinical Characteristics, Causes, and Prognosis. Circulation.
					 2009;120(11):928-934. doi:10.1161/CIRCULATIONAHA.108.827626
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3918881/
Tan VH, Ritchie D, Maxey C, Sheldon R. Prospective
					 Assessment of the Risk of Vasovagal Syncope During Driving. JACC: Clinical
					 Electrophysiology, Volume 2, Issue 2, 2016, Pages 203-208.
https://doi.org/10.1016/j.jacep.2015.10.006
.
					 (
https://www.sciencedirect.com/science/article/pii/S2405500X1500376X
)
Anne B. Curtis, MD and Andrew E. Epstein, MD Syncope While
					 Driving. How Safe is Safe? Circulation, Volume 120, Issue 11, 15 September
					 2009; Pages 921-923
https://doi.org/10.1161/CIRCULATIONAHA.109.890335
https://www.ahajournals.org/doi/epub/10.1161/CIRCULATIONAHA.109.890335
Driving is Safe for Most Patients with a History of
					 Fainting. February 8, 2016.
http://www.cardiosmart.org/news/2016/2/driving-is-safe-for-most-patients-with-a-history-of-fainting
VISION
New standards for the visual function of drivers. Report of
					 the Eyesight Working Group. Brussels. 2005.
https://ec.europa.eu/transport/road_safety/sites/roadsafety/files/pdf/behavior/new_standards_final_version_en.pdf
Driver Fitness Medical Guidelines, September 2009, DOT HS
					 811 210; National Highway Traffic Safety Administration
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