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 › Section 250-3-3 - FUNCTIONAL ABILITY PROFILES

Current through 2024-29, July 17, 2024
Functional ability to operate a vehicle safely may be
					 affected by a wide range of physical, mental or emotional impairments. To
					 simplify reporting and to make possible a comparison of relative risks and
					 limitations, the Medical Advisory Board has developed Functional Ability
					 Profiles for fourteen categories, with multiple levels under each profile.
					 Conditions that may affect the safety of a person to operate a motor vehicle,
					 but are not included in the specified categories, may be reported using the
					 general definitions listed below. Clinician recommendations to limit or expand
					 driving privileges, shorten or extend intervals for review, add or delete
					 restrictions or require a road test will be given due consideration. However,
					 the Secretary of State or their designee will make the final determination.
Each profile follows the same format and describes levels
					 or degrees of impairment. The profile levels are intended to describe potential
					 for at risk driving; they are not ment to correspond to clinical
					 definitions.
1.
No diagnosed
				  condition.
This section is used for a patient who has indicated to the
				  Bureau of Motor Vehicles a problem for which no evidence is found, or for which
				  no ongoing condition can be identified. For example, this category might apply
				  to a person with a heart murmur as a young child who indicates heart trouble,
				  or to a teenager who fainted in gym class once on a hot day who indicates
				  blackouts.
2.
Condition fully
				  recovered/compensated.
This category includes history of a condition
				  that has been resolved or does not warrant review. Guidance for the use of this
				  section is provided in each profile.
3.
Active impairment
A.
Mild.
This section deals with
				  conditions which warrant periodic medical review because of an ongoing
				  condition that could deteriorate, and/or conditions that may impair ability to
				  drive but which are controlled so that a person can still operate a motor
				  vehicle safely.
B.
Moderate.
This section deals with conditions that require more
				  frequent medical review, or may necessitate use of personal medical devices,
				  orthotics, adaptive equipment for the car, or restrictions to safely operate a
				  motor vehicle. Some conditions may require a driving test to determine fitness
				  to drive, or may preclude driving, but with potential for recovery allowing
				  safe operation of a motor vehicle.
C.
Severe.
This section deals
				  with conditions that preclude safe operation of a motor vehicle. This may be
				  due to the severity of the condition; because the condition is not controlled;
				  or because of a new condition which requires further testing and follow-up to
				  determine safety to operate.
In all cases, periodic review may result in a different
					 profile level as the condition improves or deteriorates. Tables for specific
					 conditions included within this chapter of rules, also articulate a frequency
					 of periodic review commensurate with the level of risk.
When the circumstances of an individual driver do not
					 clearly fit within the guidelines presented in these rules, the Medical
					 Advisory Board or any Member may be consulted for review, on a case-by-case
					 basis.
Reporting of temporary conditions is not required. However,
					 a person experiencing a condition or taking medications that may impair their
					 ability to safely operate a motor vehicle should refrain from operating a motor
					 vehicle until their condition improves or they are no longer taking the
					 medication.
CARDIOVASCULAR CONDITIONS PREAMBLE
Cardiovascular disease may affect a driver's ability in a
					 variety of ways, most particularly being the possibility of cardiac syncope or
					 near syncope, due to either dysrhythmia or medications/devices used to treat
					 the cardiac condition. Guidelines are provided for important categories of
					 diagnoses that may require driving restriction or periodic review.
Supraventricular Arrhythmia (SVT) and
					 Bradyarrhythmia:
In general, profile 2 would apply to individuals whose
					 arrhythmia has been of a minor nature or so remote and well controlled that the
					 patient is expected to drive without his/her condition presenting a risk to the
					 public. In other cases of Supraventricular Tachycardia, Atrial Fibrillation, or
					 bradydysrhythmias, the risk is related to the likelihood of recurrence, and the
					 likelihood that recurrence may result in alteration or loss of
					 consciousness.
Ventricular Tachycardia and Ventricular Fibrillation
					 (VT and VF)
In cases of ventricular tachycardia or ventricular
					 fibrillation risk for driving is related to the likelihood of recurrence and
					 the likelihood that recurrence may result in an alteration of level of
					 consciousness or loss of consciousness (AOC or LOC). Implantable
					 Cardioverter-Defibrillators (ICD) present special circumstances and problems.
					 Generally, a patient who receives such a device for a presenting rhythm that
					 resulted in loss of consciousness (e.g., for secondary
					 prevention,i following syncope or sudden death), or
					 a person who experiences interference with abilities needed to control a motor
					 vehicle, alteration or loss of consciousness associated with discharge of the
					 device for an abnormal rhythm, should not drive for 6 months. Driving may be
					 resumed after 6 months being free from an event. Patients who have a device
					 implanted for primary preventioni who have not
					 presented a syncopal rhythm yet, may be allowed to resume driving within a week
					 at the judgment of treating clinician.
Other Cardiac Conditions
This section includes other cardiac conditions which could
					 cause syncope or near syncope; or that are severe enough to cause symptoms at
					 rest that could affect driving or meet New York Heart Association Class IV
					 criteria. For cardiac conditions which could cause syncope or near syncope,
					 risk for driving is related to the likelihood of alteration or loss of
					 consciousness.
Clinician recommendations about resumption of driving or
					 the interval for review will be taken into consideration.
Vasovagal syncope is excluded from this FAP unless episodes
					 have occurred while driving. Driving may resume after receiving treatment and
					 being symptom free 3 months. For an unexplained alteration or loss of
					 consciousness, please refer to that FAP.
Generalized Deconditioning:
A person with generalized deconditioning which reduces
					 functional capacity should be evaluated using the "Miscellaneous
					 Musculoskeletal and Neurological Conditions" FAP.
Footnotes:
1 Primary prevention refers to
					 placement of an ICD in a person that has not experienced a sudden cardiac
					 arrest but is at high risk for such an event. Placement in a person that has
					 already experienced a cardiac event such as syncope or cardiac arrest is
					 referred to as secondary prevention.
FUNCTIONAL ABILITY PROFILE
Cardiovascular
					 Conditions1: Ventricular Tachycardia/Ventricular
					 Fibrillation1
Profile Levels
Degree of Impairment/ Potential for At Risk
								Driving
Condition Definition / Example
Interval for Review and Other
								Actions
1.
No diagnosed condition
No known history of Ventricular Tachycardia (VT) or
								Ventricular Fibrillation (VF)
N/A
2.
Condition fully recovered
Arrhythmia by history, not documented,
								asymptomatic
N/A
3.
Active impairment
(Profile levels are intended to describe potential
								for at risk driving; they are NOT consistent with clinical definitions for
								mild, moderate or severe.)
a. Mild risk
Non-syncopal, non-sustained ventricular
								tachycardia.
4 years
b. Moderate risk
Sustained VT or VF, treated with medication or
								ICD3, more than 6 months without recurrence of
								syncope.
For drivers with ICD, no pre or post shock syncope,
								alteration of consciousness, or interference with ability to control a motor
								vehicle, within past 6 months.
2 years
c. Severe risk
Sustained VT or VF untreated or treated with
								medication or ICD2 less than 6 months, or syncopal
								arrhythmia not responding to treatment; or
New or worsening established conditions under
								investigation to determine potential risk for unsafe driving.
No driving
1 For further discussion
					 regarding CARDIOVASCULAR CONDITIONS, please refer to PREAMBLE at the beginning
					 of this section.
2 ICD includes implantable
					 cardioverter defibrillators
FUNCTIONAL ABILITY PROFILE
Cardiovascular
					 Conditions1: Supraventricular
					 Arrhythmias2/Bradyarrhythmias
Profile Levels
Degree of Impairment/Potential for At Risk
								Driving
Condition Definition / Example
Interval for Review and Other
								Actions
1.
No diagnosed condition
No known history of supraventricular arrhythmias or
								bradyarrhythmias
N/A
2.
Condition fully recovered
Arrhythmias by history, not documented,
								asymptomatic; or
Documented supraventricular arrhythmias (SVT) or
								bradyarrhythmias, with none in the last 18 months and no other identified heart
								disease.
N/A
3.
Active impairment
(Profile levels are intended to describe potential
								for at risk driving; they are NOT consistent with clinical definitions for
								mild, moderate or severe.)
Documented SVT or bradyarrhythmia and excluding
								transient arrhythmias or conduction defects associated with acute myocardial
								infarction.
a. Mild risk
Documented arrhythmias associated with syncope more
								than 18 months ago, asymptomatic; and/or
A-fib or supraventricular tachycardia without
								syncope, only mildly symptomatic (e.g., dyspnea, mild lightheadedness).
6 years
b. Moderate risk
Documented arrhythmias associated with syncope
								within the past 6-18 months, mildly symptomatic (e.g., dyspnea, mild
								lightheadedness).
2 years
c. Severe risk
Documented arrhythmias associated with syncope
								within the past 6 months or symptoms that interfere with normal functioning; or
								New conditions presumed to be arrhythmic under investigation to determine
								potential risk for unsafe driving.
No driving
For further discussion regarding CARDIOVASCULAR CONDITIONS,
					 please refer to PREAMBLE at the beginning of this section.
FUNCTIONAL ABILITY PROFILE
Cardiovascular
					 Conditions1: Other
					 Cardiac2
Profile Levels
Degree of Impairment/Potential for At Risk
								Driving
Condition Definition / Example
Interval for Review and Other
								Actions
1.
No known conditions
No history of any cardiac conditions
N/A
2.
Condition fully recovered
History of a cardiac condition that has been
								resolved or does not warrant review2 according to
								FAP guidelines, and no history of cardiac syncope within the past 4
								years.
N/A
3.
Active impairment
(Profile levels are intended to describe potential
								for at risk driving; they are NOT consistent with clinical definitions for
								mild, moderate or severe.)
Any cardiac condition not specified in another FAP
								and meets the criteria below. For vasovagal episodes see
								footnote5.
Clinician must specify diagnosis & reason for
								concern.
a. Mild risk
On-going cardiac condition that warrants review due
								to risk of developing symptoms severe enough to affect ability to operate a
								motor vehicle; and/or
History of syncopal episode greater than 18 months
								but less than 4 years.
4 years
b. Moderate risk
On-going condition that warrants more frequent
								review, or
History of syncopal episode 6-18 months ago
2 years Clinician may recommend shorter interval
								for review
c. Severe risk
Condition precludes safe operation of a motor
								vehicle. This may be due to any of the following: the severity of the condition
								(E.g., angina or shortness of breath at rest or with minimal activity (NYHA
								IV)); or
Non-vasovagal syncopal episodes less than 6 months
								ago, and likelihood of recurrence unknown3, 5;
								or
New or suspected condition which requires further
								testing and follow-up to determine safety to operate; or
History of vasovagal syncope while driving or with
								high-risk features, treated for less than 3 months, or untreated. See
								footnote3
No driving Clinician must specify reason for
								suspension4
1 For further discussion
					 regarding CARDIOVASCULAR CONDITIONS, please refer to Preamble at the beginning
					 of this section.
2 Other cardiac conditions which
					 normally would not require review may include CAD, CHF, valvular heart disease
					 or others.
3 Vasovagal syncope is excluded
					 from this FAP as long as episodes have not occurred while driving or in
					 high-risk setting (occurs without warning and in any position, has no clear
					 precipitating causes, and/or occurs frequently). Driving may resume after
					 receiving appropriate treatment and being symptom free 3 months. For
					 unexplained alteration or loss of consciousness, refer to the "Unexplained
					 Alteration of Consciousness" FAP.
4 Document reason for
					 suspension, such as diagnosis and specific symptoms.
5 Definitive therapy for
					 prevention of syncope may allow driving in less than 6 months on an individual
					 basis.
CHRONIC RESPIRATORY DISEASE PREAMBLE
Chronic respiratory disease includes conditions that may
					 result in hypoxemia and chronic respiratory failure. Chronic obstructive
					 pulmonary disease (COPD) refers to those pulmonary diseases characterized by
					 obstruction to the outflow of breath, as measured by expiratory flow rates, and
					 includes emphysema, chronic bronchitis, and some forms of chronic asthma.
					 Restrictive respiratory diseases are distinct in limitation of expansion of the
					 lung and include any type of pulmonary fibrosis, chronic infection with
					 scarring, dust deposition, etc. Although the pathology is different, a final
					 common pathway for both types of respiratory disease will be breathlessness,
					 hypoxia, infections, eventual pulmonary insufficiency, and finally respiratory
					 failure. Additionally, other disease processes such as congestive heart
					 failure, cor pulmonale, pulmonary hypertension, among other disease processes
					 can lead to chronic hypoxia.
Most studies of driving ability and COPD have focused on
					 the neuropsychological effects of hypoxia. Classic studies in the 1980's found
					 difficulties in COPD patients on complex cognitive testing. Grant and
					 colleagues (1982)A studied 203 severely hypoxic
					 patients (mean PO2 of 51) and matched controls, and found 42% with cognitive
					 difficulties in the study group compared to 14% in the controls. These did not
					 correlate well with standard pulmonary function tests (PFT's). A second study
					 by Prigatano (1983)B confirmed the same type of
					 cognitive limits in slightly less hypoxic patients, mean PO2 of 66. A
					 meta-analysisC done by several of these researchers
					 in 1987 found that neuropsychological effects were correlated with level of
					 hypoxia.
Studies using driving simulators,D,
						E done by European researchers, have confirmed that even mildly
					 hypoxic patients have perceptual difficulties and perform less well than
					 controls. Few studies however have shown higher crash rates among COPD
					 patients, although some Utah driver dataF suggests
					 that persons with any pulmonary condition are at higher risk of crashes.
A recent large trial testing long-term treatment with
					 supplemental oxygen in COPD patients with moderate resting desaturation
					 (89-93%) or moderate exercise induced hypoxia was
					 performed.G There was no significant improvement in
					 time to death or hospitalizations with supplemental oxygen. In addition, there
					 was no significant difference in measures of quality of life. Thus, at this
					 time there would not be an expectation for these patients to require oxygen
					 with driving, if their resting O2 Sat > 88%.
Restrictive respiratory diseases or any other disease
					 process (CHF, pulmonary hypertension, cor pulmonale, etc.) could be subject to
					 the same driving restrictions when hypoxic respiratory failure develops.
Shorter review periods are beneficial in persons with
					 higher class of disease or those requiring oxygen (even nocturnal or partial
					 use) given that such persons are prone to exacerbations worsening their daily
					 status, prone to gradual decline, and prone to experience difficulty with
					 stressful driving conditions. Those who cannot maintain adequate oxygenation
					 with supplementation should not drive.
FUNCTIONAL ABILITY PROFILE
Chronic Respiratory
					 Disease1
Profile Levels
Degree of Impairment/Potential for At Risk
								Driving
Condition Definition / Example
Interval for Review and Other
								Actions
1.
No diagnosed condition
No history of chronic respiratory disease
N/A
2.
Condition fully recovered
Any respiratory condition, recovered or cured; or
								Minimal, reversible, episodic, controlled pulmonary condition.
N/A
3.
Active impairment
(Profile levels are intended to describe potential
								for at risk driving; they are NOT consistent with clinical definitions for
								mild, moderate or severe.)
Chronic respiratory
								disease2
a. Mild risk
COPD, restrictive respiratory diseases or other
								disease processes with mild dyspnea, able to maintain O2 Sat 89% or greater on
								room air, at rest.
4 years
b. Moderate risk
COPD, restrictive respiratory diseases or other
								disease processes with moderate dyspnea, O2 Sat 88% or less, or PaO2 55 or less
								on room air, but able to maintain
O2 Sat 89% or greater on oxygen
								supplementation
; or Exercise or sleep induced O2 sat 88% or less but
								able to maintain 89% at rest on room air.
2 year If O2 sat less than 88% (on room air) while
								at rest must use O2 while driving.
Note: Those with only sleep or exercise induced
								hypoxia are not required to use O2 while driving.
c. Severe risk
COPD, restrictive respiratory diseases or other
								disease processes with severe dyspnea and/or hypoxia that cannot be controlled
								to maintain O2 Sat 89% or greater, or PaO2 56 or greater on oxygen at rest; or
New condition with poorly controlled hypoxia,
								unable to maintain O2 sat at 89% or above, under investigation.
No driving
1 For further discussion
					 regarding CHRONIC RESPIRATORY DISEASE, please refer to PREAMBLE at the
					 beginning of this section.
2 Specify the diagnosis
DEMENTIA PREAMBLE
Many disease processes can cause dementia, most commonly
					 Alzheimer's Dementia, stroke, and Parkinson's Disease. Less common causes
					 include Lewy Body and fronto-temporal dementias, HIV and other chronic viral
					 CNS infections, B12 deficiency, chronic alcohol damage, and multiple sclerosis.
					 All dementias cause some mixture of permanent, often progressive, loss or
					 impairment of cognitive skills like memory, visuo-spatial perception, language,
					 abstraction, prosody and/or praxis impairments, and/or executive function
					 (complex reasoning, planning and judgment).
Cognitive impairment due to another diagnosis such as
					 mental health or neurodevelopmental disorders should be reviewed according to
					 the appropriate Functional Ability Profile (FAP). Dementia caused by another
					 diagnosis such as stroke, brain Injury or other medical conditions should
					 trigger completion of a profile level for the other condition as well as
					 dementia. When there are cognitive changes or other combination of deficits
					 raising concern for unsafe driving but there is no diagnosis of dementia and no
					 explanatory diagnosis, refer to the "Medical - Other" FAP. In setting of
					 unknown diagnosis, physician will need to determine appropriate work up or
					 refer to appropriate specialist.
Memory loss is usually the first symptom to occur in
					 Alzheimer's Dementia, but alone is insufficient to make that diagnosis without
					 other cognitive deficits. Memory loss may be absent or at least occur later in
					 several other types of dementia. Dementias must also be differentiated from
					 other cognitive impairments like a congenital intellectual disability,
					 transient impairments from delirium-producing conditions, or "mild cognitive
					 impairment" (MCI) which entails mild memory or other cognitive deficits but no
					 functional impairment. MCI carries no increased crash risk, nor may mild
					 dementia. However, the potential for progression in both justifies more
					 frequent physician re-evaluations.
The cognitive changes associated with dementia often affect
					 drivers' ability to operate competently and increase crash risks. Those risks
					 are elevated, especially in emergencies and in complicated traffic patterns,
					 such as at intersections, with lane changes, while merging and making left-hand
					 turns.
Unfortunately, there are no tests of driving competence
					 with 100% sensitivity/specificity. Current evidence does show several
					 potentially useful clinical associations between specific cognitive test
					 results and driving outcomes, although scoring cut-points for safe/unsafe
					 driving often vary among studies. Nevertheless, office tests of attention,
					 executive function, visuo-spatial skills, and memory are useful in assessments
					 of drivers with dementia. These include Trails B, Useful Field of View, clock
					 drawing, Snellgrove Maze Test and several others.A,
						B Testing should be tailored to the type of dementia and the
					 particular deficits identified to best capture degree and severity of the
					 impairment.C
Although clinical testing and screening have limited
					 ability to predict whether or not an individual driver may be able to pass a
					 road test, screening scores may be used as supporting evidence when selecting a
					 profile level and completing the Driver Medical Evaluation form. For example, a
					 Mini Mental Status Exam (MMSE) of 24-26+, Clinical Dementia Rating Scale (CDR)
					 <1, or Montreal Cognitive Assessment Test (MoCA) >=22 would usually be
					 associated with mild cognitive impairment and lower crash risk. An MMSE 20-23,
					 CDR 1-1.5, or MoCA 19-21 may be associated with moderate cognitive impairment
					 and greater crash risk. While an MMSE <=19, CDR 2 or greater, or
					 MoCA<=18, or deficits in visuo-spatial or executive function would often be
					 associated with greater impairment and higher crash risk. Drivers with a
					 screening (MMSE) score of <24 fail road tests 70% of the time, but 30% pass;
					 those with scores of <19 fail 95% of the time, and only 5%
					 pass.A All relevant factors, including self-report
					 or family/caregiver reports of unsafe driving, should be taken into
					 consideration. Documentation should support evidence for the diagnosis and
					 profile level written on the Driver Medical Evaluation form.
Although not all experts agree, the Driver Fitness Working
					 GroupA states that the presence of two or more of
					 the following factors may indicate the need for a cognitive assessment by a
					 health care professional. Applicants with greater numbers of risk factors
					 should be considered at greater risk, although the relative risks are not
					 necessarily additive.
1) Age 80 years
				  or older
2) History of a recent
				  crash or moving violations
3) 
				  Applicant self-report or caregiver report of impaired skills
4) Use of psychoactive medications such as
				  benzodiazepines, neuroleptics, antidepressants, or use of medications for
				  Alzheimer's Disease
5) History of
				  active alcohol abuse
6) History of
				  falls
7) Inability to understand or
				  hear instructions during interactions with the health professional
8) Scores with simple screening tools that
				  indicate the possibility of a cognitive deficit
Online medical textbooks maintain useful reviews of all
					 these issues.D
When BMV is notified that a licensed driver is diagnosed
					 with dementia, the driver will usually be required to submit a "Driver Medical
					 Evaluation" (CR-24) form, completed by an appropriate clinician. Depending on
					 the outcome of the Evaluation, the driver may also be required to take a road
					 test, which must be administered by a BMV Driver's License Examiner.
For a description of the BMV road test components, see the
					 Appendix. It should be noted that Driver License Examiners are not trained in
					 cognitive evaluation.
Online programs intended to assist older drivers
					 self-evaluate driving skills may help them to an appropriate decision to retire
					 from driving. On-road tests with a driving rehabilitation instructor,
					 occupational therapist or a driver educator may also be useful. Please be aware
					 that BMV does not normally require these evaluations and they are not a
					 substitute for the BMV road test. Refer to the appendix for more information
					 about Occupational Therapy Evaluations.
FUNCTIONAL ABILITY PROFILE
Dementia1
Profile Levels
Degree of Impairment/ Potential for At Risk
								Driving
Condition Definition / Example
Interval for Review and Other
								Actions
1.
No diagnosed condition
No diagnosed dementia, no suspected dementia of
								concern for driving.
N/A
2.
Condition fully recovered
Cognitive impairment recovered. (Rare, usually
								within 6 months of identification. Example: recovery following a
								stroke.)
N/A
3.
Active impairment
(Profile levels are intended to describe potential
								for at risk driving; they are NOT consistent with clinical definitions for
								mild, moderate or severe.)
Diagnosed dementias (not MCI), other causes having
								been ruled out. (For Lewy Body Dementia, see
								footnote2).
Or,
New cognitive impairment under investigation, see
								Dementia Preamble.
Documentation should support evidence of the
								diagnosis and profile level reported.
a. Mild risk
Consistent slight forgetfulness, or mild deficits
								in judgment and problem solving. May have mild comprehension difficulties. No
								evidence of executive dysfunction or visuo-spatial impairment.
No known driving impairment.
2 years3
ROAD TEST if recommended by clinician
b. Moderate risk
Cognitive impairment interferes with everyday
								activities and there may be geographic disorientation, or deficits in judgment,
								difficulty problem solving or managing sudden events. Without significant
								evidence of executive dysfunction or visuo-spatial impairment.
Potential concern for driving impairment.
1 year3
ROAD TEST
c. Severe risk
Cognitive impairment significant to the point that
								new information is not retained; or judgment and problem solving significantly
								impaired; or there is disorientation to time and place or may be unable to
								manage complex chores or activities; or
History of unsafe driving; or driving is not safe
								in judgment of clinician; or
New cognitive impairment under investigation for
								dementia, with concern for potentially unsafe driving.
No driving Documentation supports evidence of the
								diagnosis and profile level reported
1 For further discussion
					 regarding DEMENTIA, please refer to PREAMBLE at the beginning of this
					 section.
2 Lewy Body Dementia exhibiting
					 significant movement disorder manifestations should also be reviewed using the
					 Parkinson's FAP.
3 If clinician documents
					 progression of disease and recommends more frequent review and road testing,
					 the interval may be shortened.
HYPOGLYCEMIA PREAMBLE
Hypoglycemia involving a loss of consciousness or requiring
					 third party assistance is incompatible with driving and is especially
					 concerning when accompanied by hypoglycemia unawareness. Examples of requiring
					 third party assistance include but are not limited to:
(1) The driver became so confused while
				  hypoglycemic that they got lost while driving and had to call for
				  help;
(2) A driver had an alteration
				  of consciousness while hypoglycemic that required someone else to get them to
				  eat or drink something in order to recover.
Some drivers whom the clinician feels are not treating the
					 hypoglycemia condition properly may not be safe to drive, even though they have
					 not had a hypoglycemic episode involving a loss of consciousness or requiring
					 third party assistance. In these cases, the clinician should consider public
					 safety and contact the BMV for guidance.
Drivers with other conditions should be assessed under the
					 appropriate guidelines, e.g., diabetic retinopathy should be reviewed using the
					 Visual Acuity profile, peripheral neuropathy should be reviewed using the
					 Miscellaneous Musculoskeletal and Neurological Disorders profile.
FUNCTIONAL ABILITY PROFILE
Hypoglycemia1
Profile Levels
Degree of Impairment/Potential for At Risk
								Driving
Condition Definition / Example
Interval for Review and Other
								Actions
1.
No diagnosed condition
No history of hypoglycemic episodes involving a
								loss of consciousness or requiring third party assistance.
N/A
2.
Condition fully recovered
No hypoglycemic episodes involving a loss of
								consciousness or requiring third party assistance within past 3 years.
N/A
3.
Active impairment
(Profile levels are intended to describe potential
								for at risk driving; they are NOT consistent with clinical definitions for
								mild, moderate or severe)
At least one episode of hypoglycemia involving a
								loss of consciousness or requiring third party assistance within the past 3
								years.
Refer to hypoglycemia "Preamble" for others at high
								risk.
a. Mild risk
History of hypoglycemia involving a loss of
								consciousness or requiring third party assistance, more than 12 months ago but
								fewer than 3 years ago.
3 years
b. Moderate risk
i. One or more episodes of hypoglycemia involving a
								loss of consciousness or requiring third party assistance between 3-12 months
								ago, with hypoglycemia awareness; or
1 year
ii. One or more episodes of hypoglycemia involving
								a loss of consciousness or requiring third party assistance between 3-12 months
								ago and has hypoglycemia unawareness. The clinician should mark this on the
								Driver Medical Evaluation form and work with the patient to develop a plan of
								action to improve awareness.2
3 months
c. Severe risk
One or more hypoglycemic episodes involving a loss
								of consciousness or requiring third party assistance, within the past 3 months.
No driving
1 For further discussion
					 regarding HYPOGLYCEMIA, please refer to Preamble at the beginning of this
					 section.
2 Examples: Increased glucose
					 target to prevent hypoglycemia or introduce a real-time continuous glucose
					 monitor (CGM) or increase finger stick glucose testing frequency.
MENTAL HEALTH CONDITIONS PREAMBLE
There is no certain way of predicting which persons with
					 mental health conditions will have accidents, but many high-risk drivers are
					 such because of symptoms from mental health conditions. In a review of medical
					 literature spanning 1960-2000, the National Highway Traffic Safety
					 Administration noted that people with schizophrenia, personality disorders and
					 chronic alcohol abuse are at highest risk for unsafe
					 driving.A (Guidelines for Substance Use Disorders
					 are listed in a separate FAP.)
Given that many mental health conditions wax and wane in
					 severity, this FAP attempts to provide guidelines that protect public safety
					 but allow driving when possible. Recommendations are drawn from a review of
					 medical literature, a review of recommendations from other jurisdictions, and
					 from the experiences of physicians in Maine.
Diagnosis of a mental health condition is important, but
					 clinicians should also focus on a patient's function, in particular attention
					 and concentration, executive function (or other cognitive functioning as it
					 relates to the mental health condition), psychosis, psychomotor retardation,
					 response disinhibition or impulsivity, intent for dangerousness to self or
					 others, and on whether or not the patient has the insight to recognize
					 limitations or the judgment to stop driving if limiting symptoms occur.
When assessing safety and stability, clinicians should also
					 consider patient histories and collateral information about motor vehicle
					 crashes, driving citations, relapses in substance use disorder, patient
					 compliance with treatment, and relapses in the mental health condition for
					 which the patient is being treated in order to gain a fuller picture of the
					 patient's ability to drive safely. One episode of poor judgment does not
					 necessarily mean a patient should stop driving. There should be a pattern of
					 concerning behaviors or symptoms.
Many individuals with mental health conditions are
					 maintained on medications on an outpatient basis. These drugs have varying
					 degrees of sedative side effects and can potentiate other central nervous
					 system depressants. Persons receiving such medications should be screened in
					 terms of severity of side effects incident to medication and the adequacy of
					 the remission of symptoms related to the mental health condition, as it relates
					 to operating a motor vehicle.
Normally, BMV will not require reporting of prescribed
					 medications used as ordered. However, in cases where proper use of prescription
					 medications have resulted in driver impairment, such as OUI, crashes, reports
					 of unsafe driving, or when a clinician is concerned that a patient may be
					 non-compliant with driving recommendations, use of the Prescription Medications
					 and/or Opioid Replacement Therapy FAP is appropriate. Please note that
					 clinicians are responsible to assess their patients for potential risk and
					 advise them whether to drive or not based on their medications and medical
					 conditions.
Medications that are of particular concern for sedation,
					 especially if patients are prescribed more than two or are concurrently
					 prescribed opioids, are using marijuanaB, C, D, E or
					 abusing drugs or alcohol,F include the tricyclic
					 antidepressants, sedative hypnotics, some antipsychotics, and benzodiazepines.
					 Methadone and benzodiazepines are a particularly troubling combination for risk
					 of sedation. (See Substance Use Disorder FAP if that is primary
					 diagnosis).
Special Circumstances
Electroconvulsive Therapy (ECT):
A seizure induced by ECT treatment is not considered a
					 Seizure Disorder for purposes of driving a motor vehicle. Transient confusion
					 or cognitive changes would be expected to clear in a day or two after
					 treatment, during which the patient should not drive. However, it is possible
					 for ECT treatments to result in long-lasting cognitive changes that impair the
					 ability to drive safely, usually in the context of evolving dementia. Under
					 these circumstances evaluate according to the Dementia FAP.
Psychogenic Non-epileptic Seizures (PNES):
PNES are considered to be a form of Conversion Disorder in
					 DSM-V (the most recent DSM at the time this FAP was written).G,
						H Until a formal diagnosis of PNES has been made (consultation
					 with Neurology and EEG Video Monitoring are especially helpful in this regard),
					 clinicians should use the FAP for Seizures even if PNES is suspected. Once PNES
					 is formally diagnosed, the evaluation of driver safety should be individualized
					 but patients with PNES are very likely to fall within Profile Level 3b or 3c on
					 this FAP. There is no clear consensus in the medical literature about driving
					 limitations for PNES, but in a study in the United Kingdom, 50% of neurologists
					 who specialize in diagnosing PNES felt that driving restrictions should be
					 similar to that for epilepsy. There are reports of motor vehicle crashes
					 related to PNES.I Prognosis for cessation of
					 psychogenic seizures is better if PNES resolves spontaneously in the first year
					 or two, but poor if the symptoms have gone on for 10 or more years.
Medical conditions with mental health
					 symptoms:
Other conditions may at times be associated with mental
					 health symptoms and may require review using this FAP. Examples may include but
					 are not limited to Parkinson's or Tourette's Syndrome.
Novel treatments or treatment in development:
Transcranial Magnetic
					 StimulationJ and intravenous ketamine are examples
					 of new or novel treatments at the time of this FAP preparation that have no
					 track record in the medical literature as far as driver safety is concerned
					 (but are not meant to be the only treatments considered here). Practitioners
					 using any new or novel treatments are strongly urged to consider a patient's
					 ability to drive safely as part of their post-treatment assessment
					 protocols.
FUNCTIONAL ABILITY PROFILE
Mental Health
					 Conditions1
Profile Levels
Degree of Impairment/Potential for At Risk
								Driving
Condition Definition / Example
Interval for Review and Other
								Actions
1.
No diagnosed condition
No history of mental health condition.
N/A
2.
Condition fully recovered
Diagnoses of depression, anxiety, Autism, or ADHD
								(ADD), but no association with functional impairment in the past 2 years or
								more in the judgment of the treating clinician; or History of a mental health
								condition in sustained remission 2 years or more. No functional impairment in
								the judgment of the treating clinician. No impairment in driving abilities from
								medication/treatment side effects and does not meet criteria listed in sections
								below.
N/A
3.
Active impairment
(Profile levels are intended to describe potential
								for at risk driving; they are NOT consistent with clinical definitions for
								mild, moderate or severe.)
On-going symptoms that meet current DSM criteria
								for a mental disorder.2, 3
Please refer to Mental Health Conditions Preamble
								for "Special Circumstances".
a. Mild risk
Condition stable but less than 2 years; no concerns
								related to current cognitive function and only minimal functional impairment
								from symptoms or medications or other treatments; or
Occasional recurrence of mild to moderate symptoms
								without suicidal or homicidal intent and with insight and judgment adequate to
								stop driving if functional limitations or medication side effects occur.
2 years or less if recommended by clinician
b. Moderate risk
History of symptoms that might jeopardize safe
								operation of a motor vehicle but stable for at least 3 months and fit to drive;
								and
No concerns related to current cognitive function.
								Demonstrates overall compliance with treatment/recovery plan, has insight and
								judgment adequate to stop driving if functional limitations or medication side
								effects occur; and
Does not exhibit symptoms that might jeopardize
								safe operation, such as suicidal or homicidal intent, aggressive or violent
								behaviors, impulsivity, psychosis, inattentiveness.
NOTE: Clinician may recommend a road test when
								appropriate and SHOULD recommend a road test if transitioning from Profile
								Level 3c to Profile Level 3b, or if returning to driving after 6 months or more
								of no driving.
1 year or less if recommended by clinician
ROAD TEST5 if
								recommended by clinician
c. Severe risk
Currently, or within the past 3 months, has
								exhibited symptoms that might jeopardize safe operation of a motor vehicle
								and/or has not demonstrated overall compliance with treatment/recovery
								plan.
Symptoms that may jeopardize safe operation may
								include significant executive function or cognitive impairment related to a
								mental health condition, chronic dangerous
								behaviors4 toward self or others, chronic suicidal
								or homicidal intent; severe anger, impulsivity or irritability that create a
								driving hazard; chronic delusions6 or
								hallucinations6 that impair driving ability; chronic
								poor insight and judgment about driving limitations leading to dangerous
								behaviors; chronic medication or treatment side effects that impair safe
								vehicle operation, such as sedation, blurred vision or certain movement
								disorders; or
New condition or onset of symptoms, under
								investigation
and
that may pose risk to safe operation of a motor
								vehicle.
No driving
1 For further discussion
					 regarding MENTAL HEALTH CONDITIONS, please refer to Preamble at the beginning
					 of this section.
2 For substance use or
					 withdrawal disorders, please see FAP for Substance Use Disorders.
3 Diagnoses of depression,
					 anxiety, Autism, or ADHD (ADD) are common disorders and require consideration
					 in this section. They require on-going review when associated with functional
					 impairment within the past 2 years, in the judgement of the treating
					 clinician.
4 Dangerous behaviors include
					 but are not limited to those described.
5 For a description of BMV road
					 test, please refer to the Appendix.
6 Examples of hallucinations and
					 delusions that create risk for unsafe driving include but are not limited to
					 those that cause the person to take action, cause distraction or startling, or
					 command hallucinations.
MUSCULOSKELETAL AND NEUROLOGICAL DISORDERS
					 PREAMBLE
There are a wide variety of neurologic and musculoskeletal
					 disorders which can impact driving safety. Impairment may be the result of
					 altered muscular, skeletal, neurologic, and/or cognitive function. Motor,
					 sensory, and/or cognitive deficits may adversely affect strength, coordination,
					 reaction time, range of motion, visual perception, processing speed, judgment,
					 problem solving, attention, memory, and/or awareness, in terms of a driver's
					 ability to perform the actions necessary to safely operate a motor
					 vehicle.
Disorders affecting cognition such as epilepsy, stroke,
					 traumatic brain injury, Parkinson's disease, dementia, as well as disorders
					 affecting neuromuscular function such as multiple sclerosis, Parkinson's
					 disease, muscular dystrophy, cerebral palsy, myasthenia gravis, amyotrophic
					 lateral sclerosis, spinocerebellar ataxia, foot drop, neuropathy, and spinal
					 cord disorders all may present their own unique barriers to safe motor vehicle
					 operation. What's more, there is considerable overlap in the clinical
					 manifestations of these disorders. A driver with these conditions may have
					 chronic functional limitations that have the potential to affect safe operation
					 of a motor vehicle and should be evaluated.
When functional abilities are
					 in question, a road test may be recommended by the clinician or required by
					 BMV. A description of the road test may be found in the Appendix.
Many of these conditions may result in symptoms or
					 impairments that fall under more than one Functional Ability Profile (FAP) and
					 will need to be evaluated using more than one FAP. For example, following a
					 stroke a driver may experience a motor deficit which requires them to use
					 adaptive equipment for their vehicle and may also have a visual field or acuity
					 disturbance. A person with Parkinson's Disease may have cognitive or
					 psychiatric deficits as well as the neurological and motor deficits. They would
					 need to be evaluated using the Parkinson's, as well as the Dementia or Mental
					 Health Conditions FAP. A person with Tourette's Syndrome may exhibit symptoms
					 that should be reviewed using the Mental Health Conditions FAP. BMV will use
					 the most restrictive FAP to determine the fitness of a person to drive.
Neurological disorders may have an unpredictable, episodic,
					 or progressive course and require periodic evaluation by a qualified medical
					 practitioner. The treating clinician may recommend the timing of evaluation but
					 should have a working knowledge of a driver's
current
condition when filling out the Driver Medical Evaluation (CR-24) form.
When completing the CR-24 the driver must have been seen within the past
					 12 months or less.
Individuals with any number of neurological and
					 musculoskeletal conditions may use adaptive equipment when driving.
Person's that use adaptive driving aids for the vehicle must take a road
					 test.
Although referral to a driving rehabilitation specialist may be
					 indicated in some cases, it is not required by BMV. When BMV requires a road
					 test, it will be administered by a BMV Driver's License Examiner. The road test
					 will determine whether the person is allowed to drive and if there are driving
					 restrictions.
A description of a comprehensive OT driving evaluation and
					 the BMV the road test may be found in the Appendix
.
Adaptive
					 driving aids for the vehicle may include but are not limited to hand controls,
					 pedal extenders, seat modifications, etc.
Driver's that are prescribed personal assistive medical
					 devices for a chronic condition will be required to take a road test.
Personal assistive medical devices include
but are not limited to
					 a wheelchair, prosthesis, orthosis, walker, or a cane when required for normal
					 ambulation. If a cane is the only medical device needed, the clinician may
					 recommend that the road test be waived.
Conditions which require review include but are not
					 limited to the following:
Amputation or Limb Deficiency:
Amputation or limb deficiencies may be either congenital or
					 acquired of the upper or lower extremities, with functional implications to
					 safe driving being the decreased ability to operate one or more of the vehicle
					 controls. Adaptive driving aids for the vehicle will require consideration
					 depending on the specific limb deficiency, use of prosthesis and overall
					 functional abilities of the person. Evaluation by a driving rehabilitation
					 specialist may be appropriate depending on the extent of impairment. However,
					 it is not required and does not take the place of the BMV road test. The
					 Miscellaneous Musculoskeletal and Neurological Functional Ability Profile
					 should be used to assess potential for driving impairment.
Arthritis or Joint Disorders:
This category would include related conditions such as
					 rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, and spinal
					 stenosis, among others. Affected structures include joints and/or spinal
					 nerves. These conditions can cause pain, decreased strength and range of
					 motion, and impaired functional mobility, potentially altering the ability to
					 safely operate motor a motor vehicle. In assessing these persons for potential
					 driving impairment, overall functional performance of the person in terms of
					 ability to perform activities of daily living should be taken into
					 consideration to help determine if adaptive driving aids for the vehicle or
					 other strategies may be needed. The Miscellaneous Musculoskeletal and
					 Neurological Conditions Functional Ability Profile should be used to assess
					 driving impairment.
Brain Injury:
Brain injury causes dysfunction of the central nervous
					 system resulting from trauma or forces to the head significant enough to alter
					 brain function. Cognitive changes after a brain injury can affect mood, memory,
					 executive function, judgment, initiation, attention, and problem-solving. In
					 addition, because self-awareness and judgment may be affected, a person may not
					 be able recognize their impairments. Depending on the extent of the injury,
					 other deficits may include altered gait, balance and sensation, as well as
					 impaired muscle and joint function due to weakness, spasticity, and
					 contracture. These persons may require ankle-foot orthoses or upper extremity
					 orthotics to improve mobility and use of extremities. Factors that impact the
					 ability to drive safely after a brain injury can be extensive, and a
					 comprehensive driving evaluation by a driving rehabilitation specialist should
					 be considered. Use the Stroke/Brain Injury Functional Ability Profile to assess
					 impairment. Other medical impairments following brain injury may include but
					 are not limited to seizures and visual disturbances. These may need evaluation
					 separately using the additional Functional Ability Profile.
Cerebrovascular Accident (CVA or
					 Stroke):
Stroke may have a complicated and variable presentation.
					 Residual impairments may include altered strength, mobility, coordination,
					 motor planning, sensation, spatial planning, body or environmental awareness,
					 vision, communication, judgment, and cognition. Motor deficits or contractures
					 may require upper or lower extremity personal assistive medical devices or
					 adaptive driving aids for the vehicle.
Due to the possibility of multiple potential deficits, a
					 comprehensive evaluation by a driving rehabilitation specialist may be
					 indicated but is not required. Use the Brain Injury/Stroke Functional Ability
					 Profile to assess impairment. Other medical impairments following a stroke may
					 include but are not limited to seizures, aphasia and/or visual disturbances.
					 These may need to be evaluated separately using the additional Functional
					 Ability Profile.
Please note that a transient ischemic attack (TIA)
by definition has no residual deficit and is therefore not subject to
					 the Stroke FAP.
Miscellaneous Musculoskeletal and Neurological
					 Conditions
Neurologic and musculoskeletal conditions with the
					 potential to impair a person's ability to safely operate a motor vehicle are
					 numerous, and therefore have not all been specifically listed.
Even if
					 these conditions have not been adequately identified in any of the other
					 categories, they still should be evaluated.
Examples of neuromuscular
					 conditions which would be appropriately evaluated using the Miscellaneous
					 Musculoskeletal and Neurological Conditions FAP include but are not limited to
					 muscular dystrophy, cerebral palsy, amyotrophic lateral sclerosis,
					 peripheral/other neuropathies, syringomyelia, non-stroke related aphasia,
					 Tourette's Syndrome, as well as any
generalized deconditioning
					 syndrome
due to any etiology which reduces functional capacity to drive.
					 These conditions may require personal assistive medical devices or adaptive
					 driving aids for the vehicle, cause deficits in mobility, sensation, strength,
					 coordination, reaction time, range of motion, and/or other abilities needed to
					 safely operate a motor vehicle. Referral to a driving rehabilitation
					 specialist, although not required, may be indicated in some cases. Also,
					 persons who have an implanted spinal cord/dorsal column stimulator are advised
					 to turn off the device prior to driving due to the potential for unexpected
					 changes in stimulation with activity that could possibly be unsafe.
When
					 visual, cognitive, psychiatric or other conditions also exist, they should be
					 evaluated separately using the appropriate profile.
If a clinician has concerns regarding an individual's
					 ability to operate a vehicle safely that are not captured in this FAP, a road
					 test may be requested. Include documentation of all pertinent medical concerns
					 and the rationale for requesting a road test.
Multiple Sclerosis (MS):
Multiple Sclerosis is a highly variable disorder. Some
					 people may have few if any perceptible symptoms associated with the disorder,
					 while others may be significantly impaired. MS may cause visual impairment,
					 cognitive impairment, alterations in sensation, muscle weakness,
					 incoordination, spasticity, or joint contracture. Upper and/or lower extremity
					 orthotics may be required, or a person may require vehicle adaptations or be
					 operating a vehicle from a mobility device (such as a wheelchair). These
					 deficits may cause difficulties with manipulation of vehicle controls, and
					 driver performance in complex driving environments. Comprehensive evaluation
					 for adaptive driving aids and an evaluation by a driving rehabilitation
					 specialist may be beneficial but is not required. The progressive nature of MS
					 warrants periodic reassessment of driving risk using the MS Functional Ability
					 Profile. Psychiatric, cognitive, or visual deficits should be evaluated
					 separately using the appropriate Functional Ability Profile.
Parkinson's or Parkinsonian Syndromes:
Parkinson's Disease and Parkinsonism physical signs include
					 tremor, bradykinesia, postural instability, and rigidity, along with complex
					 cognitive issues such as dementia and mood disturbance. These deficits may
					 cause slowed reaction times, difficulties with vehicle controls, and impaired
					 performance in complex driving environments further complicated by medication
					 efficacy. Evaluation by a driving rehabilitation specialist may be indicated.
					 The progressive nature of the disorder warrants periodic reassessment using the
					 Parkinson's Functional Ability Profile. Psychiatric or cognitive issues should
					 be evaluated separately using the appropriate Functional Ability
					 Profile.
For the purpose of this FAP, Progressive Supranuclear
					 Palsy, Multisystem Atrophy, Corticobasal Ganglionic Degenerations, Medication
					 Induced Parkinsonism and Lewy Body Dementia are considered Parkinsonian
					 Syndromes. The cognitive implications of Lewy Body Dementia should be reviewed
					 using the Dementia FAP. Other movement disorders should be reviewed using the
					 Miscellaneous Musculoskeletal and Neurological Conditions FAP.
Spinal Cord Injury (SCI):
SCI of the cervical, thoracic, or lumbosacral regions is
					 the result of a medical condition, lesion or trauma to the neural elements
					 within the spinal canal. This causes impairment of motor and sensory function
					 to the upper or lower limbs and trunk which is variable and depends on the
					 level of injury. Although common terms to describe spinal cord injury are
					 paraplegia and tetraplegia (quadriplegia), The American Spinal Injury
					 Association (ASIA) Impairment Scale more precisely grades the degree of
					 impairment according to the spinal level of preserved motor and sensory
					 function. Safe driving after SCI may be impaired due the altered ability to
					 operate vehicle controls; so use of orthotics, adaptive driving aids for the
					 vehicle, and an adapted motor vehicle for use with mobility device/wheelchair
					 are often required. Comprehensive evaluation by a driving rehabilitation
					 specialist should be considered. The Miscellaneous Musculoskeletal and
					 Neurological Conditions Functional Ability Profile should be used to assess
					 driving impairment.
FUNCTIONAL ABILITY PROFILE
Cerebrovascular Accident (CVA/Stroke) or Brain
					 Injury1
Profile Levels
Degree of Impairment/Potential for At Risk
								Driving
Condition Definition / Example
Interval for Review and Other
								Actions
1.
No diagnosed condition
No history or stroke or brain injury.
N/A
2.
Condition fully recovered
History of stroke or brain injury without residual
								physical, cognitive or vision deficits or impairments.
Does not require personal assistive medical
								devices2 or adaptive driving aids for the vehicle as
								a result of the stroke or brain injury.
N/A
3.
Active impairment
(Profile levels are intended to describe potential
								for at risk driving; they are NOT consistent with clinical definitions for
								mild, moderate or severe.)
History of stroke or brain injury with
								residual3 cognitive, physical or vision deficits.
								For TIA, see.4
Please document residual deficits on Driver Medical
								form.
a. Mild risk
Residual3 cognitive,
								physical or vision deficits, but unlikely risk to safely operating a motor
								vehicle and does not require personal assistive medical or
								devices2 or adaptive driving aids for the vehicle;
								or
Clinician documents stable 3b condition that is
								unlikely to deteriorate, and driver has already passed a road test.
N/A Clinician may request ROAD TEST if
								unsure5, 6
b. Moderate risk
Residual3 cognitive,
								physical or vision deficits that could potentially impair ability to safely
								drive, and/or requires personal assistive medical
								devices2 or adaptive driving aids for the
								vehicle.
4 years ROAD TEST5,
								  6
c. Severe risk
Residual3 cognitive,
								physical or vision deficits that are significant enough to impair ability to
								safely drive; or
Cognitive, physical or vision changes when stroke
								is suspected, and condition is being investigated.
No driving
1 For further discussion
					 regarding CEREBROVASCULAR ACCIDENT OR BRAIN INJURY, please refer to Preamble at
					 the beginning of this section.
2 Driver's that are prescribed
					 personal assistive medical devices for a chronic condition, such as but not
					 limited to a wheelchair, prosthesis, orthosis, walker, or a cane when required
					 for normal ambulation will be required to take a road test. If a cane is the
					 only medical device needed, the clinician may recommend that the road test be
					 waived.
3 Stroke and brain injury may
					 lead to other impairments that need to be evaluated using an additional FAP,
					 such as seizures, visual deficits such as hemianopsia or diplopia. The most
					 restrictive Profile will determine the driving privileges.
4 Please note that a transient
					 ischemic attack (TIA) by definition has no residual deficit and is therefore
					 not subject to this FAP.
5 If a clinician has concerns
					 regarding an individual's ability to operate a vehicle safely that are not
					 captured in this FAP, a road test may be requested. Include documentation of
					 all pertinent medical concerns, and rationale for requesting road test.
6 Refer to the appendix for more
					 information about BMV Road Tests and Comprehensive Occupational Therapy Driving
					 Evaluations. On-road tests with a driving rehabilitation instructor,
					 occupational therapist or a driver educator may be appropriate in some
					 situations, but BMV does not normally require these evaluations and they are
					 not a substitute for the BMV road test.
FUNCTIONAL ABILITY PROFILE
Miscellaneous Musculoskeletal and Neurological
					 Disorders1
Profile Levels
Degree of Impairment/Potential for At Risk
								Driving
Condition Definition / Example
Interval for Review and Other
								Actions
1.
No diagnosed condition
No history of musculoskeletal or neurological
								condition(s)
N/A
2.
Condition fully recovered
History of injury, deficiency, disorder, or other
								condition recovered, no longer requires treatment and maintains normal
								function; and does not require use of personal assistive medical
								devices2 or adaptive driving aids for the
								vehicle.
N/A
3.
Active impairment
(Profile levels are intended to describe potential
								for at risk driving; they are NOT consistent with clinical definitions for
								mild, moderate or severe.)
Chronic condition such as amputation or limitation
								of limb, arthritis, joint disorders, spinal cord injury, non-Parkinsonian
								movement disorders, or others which may affect neuromuscular function; and
								currently requires treatment or cause impairments, restrictions, or deficits.
For spinal cord/dorsal column stimulator
								see3.
If clinician has concerns that are not captured in
								this FAP, see footnote4
a. Mild risk
Chronic condition that does not pose risk for safe
								driving and does not require use of personal assistive medical
								devices2 or adaptive driving aids for the vehicle;
								or
Clinician documents stable Profile Level 3b
								condition that is unlikely to deteriorate, and driver has already passed road
								test.
N/A4
b. Moderate risk
Chronic condition, which may impair ability to
								drive safely and/or requires use of personal assistive medical
								devices2 or adaptive driving aids for the vehicle,
								such as hand/foot controls.
4 years5
ROAD TEST5, 6
c. Severe risk
Chronic condition which causes impairments that
								interfere with the ability to operate safely.
No driving
1 For further discussion
					 regarding MISCELLANEOUS MUSCULOSKELETAL AND NEUROLOGICAL DISORDERS, please
					 refer to Preamble at the beginning of this section.
2 Driver's that are prescribed
					 personal assistive medical devices for a chronic condition, such as but not
					 limited to a wheelchair, prosthesis, orthosis, walker, or a cane when required
					 for normal ambulation will be required to take a road test. If a cane is the
					 only medical device needed, the clinician may recommend that the road test be
					 waived.
3 Persons who have an implanted
					 spinal cord/dorsal column stimulator are advised to turn off the device prior
					 to driving due to the potential for unexpected changes in stimulation with
					 activity that could possibly be unsafe.
4 If a clinician has concerns
					 regarding an individual's ability to operate a vehicle safely that are not
					 captured in this FAP, a road test may be requested. Include documentation of
					 all pertinent medical concerns, and rationale for requesting a road
					 test.
5 Interval for review and road
					 test may be more frequent if recommended by clinician.
6 Refer to the appendix for more
					 information about BMV Road Tests and Comprehensive Occupational Therapy Driving
					 Evaluations. On-road tests with a driving rehabilitation instructor,
					 occupational therapist or a driver educator may be appropriate in some
					 situations, but BMV does not normally require these evaluations and they are
					 not a substitute for the BMV road test.
FUNCTIONAL ABILITY PROFILE
Multiple
					 Sclerosis1
Profile Levels
Degree of Impairment/Potential for At Risk
								Driving
Condition Definition / Example
Interval for Review and Other
								Actions
1.
No diagnosed condition
No diagnosed multiple sclerosis
N/A
2.
Condition fully recovered
There is no recovery from multiple sclerosis
N/A
3.
Active impairment
(Profile levels are intended to describe potential
								for at risk driving; they are NOT consistent with clinical definitions for
								mild, moderate or severe.)
Multiple sclerosis may affect many domains of the
								nervous system including cognition, vision, motor skills, coordination etc. In
								addition, it may cause fatigue and/or psychiatric
								symptoms.2
a. Mild risk
Symptoms2 well
								controlled, or condition is quiescent. No side effects from medications that
								could potentially impair driving. No personal assistive medical
								devices3 or adaptive driving aids for the vehicle;
								or
Clinician documents stable 3b condition that is
								unlikely to deteriorate, and driver has already passed a road test.
4 years4
b. Moderate risk
Symptoms2 or medication
								side effects that may potentially impair safe driving and/or requires personal
								assistive medical devices3 or adaptive driving aids
								for the vehicle.
2 years ROAD TEST3,
								  5
c. Severe risk
Symptoms2 or side
								effects of medication severe enough to impair safe driving.
No driving
1 For further discussion
					 regarding MULTIPLE SCLEROSIS, please refer to Preamble at the beginning of this
					 section.
2 Multiple Sclerosis is highly
					 variable. Some people may have few if any perceptible symptoms associated with
					 the disorder, while others may be significantly physically or cognitively
					 impaired. Symptoms may fall under more than one FAP and all appropriate FAP's
					 should be used. For example, a driver may require vehicle modifications or have
					 a significant visual field or acuity disturbance. The most restrictive FAP will
					 determine driving privileges or restrictions.
3 Driver's that are prescribed
					 personal assistive medical devices for a chronic condition, such as but not
					 limited to a wheelchair, prosthesis, orthosis, walker, or a cane when required
					 for normal ambulation, will be required to take a road test. If a cane is the
					 only medical device needed, the clinician may recommend that the road test be
					 waived.
4 Clinician may recommend a
					 longer interval for review for those whose condition is quiescent or stable and
					 well controlled, and without concerning side effects from medications.
5 Refer to the appendix for more
					 information about BMV Road Tests and Comprehensive Occupational Therapy Driving
					 Evaluations. On-road tests with a driving rehabilitation instructor,
					 occupational therapist or a driver educator may be appropriate in some
					 situations, but BMV does not normally require these evaluations and they are
					 not a substitute for the BMV road test.
FUNCTIONAL ABILITY PROFILE
Parkinson's and Parkinsonian
					 Syndromes1
Profile Levels
Degree of Impairment/Potential for At Risk
								Driving
Condition Definition / Example
Interval for Review and Other
								Actions
1.
No diagnosed condition
No diagnosed
								Parkinson's2
N/A
2.
Condition fully recovered
Parkinson's Disease and/or Parkinsonian
								Syndromes2 are lifelong conditions and there is no
								recovery.
Drug induced Parkinsonism may be considered
								recovered when symptoms resolve after the causative medication is
								stopped.
N/A
3.
Active impairment
(Profile levels are intended to describe potential
								for at risk driving; they are NOT consistent with clinical definitions for
								mild, moderate or severe.)
Parkinson's Disease and/or Parkinsonian
								Syndromes2 may cause tremor, autonomic instability,
								rigidity, bradykinesia and/or dyskinesia, cognitive or psychiatric
								symptoms.3,
a. Mild risk
Mild physical symptoms that do not pose risk for
								safe operation of a vehicle. No cognitive or psychiatric
								symptoms.3 Medications do not cause impairment. Does
								not require personal assistive medical devices5 or
								adaptive driving aids for the vehicle.
2 years4, 5
b. Moderate risk
Physical symptoms and/or side effects of medication
								may potentially interfere with the safe operation of a motor vehicle. May have
								early cognitive or psychiatric symptoms;3 and/or
								require personal assistive medical devices5 or
								adaptive driving aids for the vehicle.
1 year ROAD TEST5,
								  6
c. Severe risk
Physical symptoms or side effects of medications
								are incompatible with safe operation of a motor vehicle. For cognitive or
								psychiatric symptoms, see3.
No driving
1 For further discussion
					 regarding PARKINSON'S OR PARKINSONIAN SYNDROMES, please refer to Preamble at
					 the beginning of this section.
2 For the purpose of this FAP,
					 Lewy Body Dementia, Multisystem Atrophy, Corticobasal Ganglionic Degenerations,
					 medication induced Parkinsonism, Vascular Parkinsonism, and Progressive
					 Supranuclear Palsy are considered Parkinsonian Syndromes.
3 Cognitive or Psychiatric
					 symptoms should be evaluated using the Dementia or Mental Health Conditions
					 FAP.
4 When Parkinsonian Syndrome is
					 caused by medications and patient is stable, the clinician may recommend
					 extending the review interval up to 4 years.
5 Driver's that are prescribed
					 personal assistive medical devices for a chronic condition, such as but not
					 limited to a wheelchair, prosthesis, orthosis, walker, or a cane when required
					 for normal ambulation will be required to take a road test. If a cane is the
					 only medical device needed, the clinician may recommend that the road test be
					 waived.
6 Refer to the appendix for more
					 information about BMV Road Tests and Comprehensive Occupational Therapy Driving
					 Evaluations. On-road tests with a driving rehabilitation instructor,
					 occupational therapist or a driver educator may be appropriate in some
					 situations, but BMV does not normally require these evaluations and they are
					 not a substitute for the BMV road test.
NARCOLEPSY OR IDEOPATHIC HYPERSOMNIA
					 PREAMBLE
Narcolepsy is a chronic condition of the central nervous
					 system characterized by the brain's inability to control sleep-wake cycles. The
					 prevalence is not clear but estimated at approximately 0.1% of the US
					 population.A Many researchers believe the condition
					 remains undiagnosed or underdiagnosed in many affected individuals. At various
					 times throughout the day, people with narcolepsy can experience excessive
					 daytime sleepiness: the onset of sleep is usually heralded by awareness of
					 sleepiness which usually becomes more predictable over time and with
					 experience. In addition to daytime sleepiness, other symptoms can include
					 cataplexy which is the sudden loss of voluntary muscle tone triggered by strong
					 emotions, sleep paralysis, sleep hallucinations, and disturbed night sleep.
					 Symptoms commonly begin in the teen years but may occur later in life as
					 well.
The diagnosis of narcolepsy should be made by a physician
					 (generally a sleep specialist, neurologist or pulmonologist). When possible,
					 these patients are frequently followed by these same specialists or their
					 associated nurse practitioners and physician assistants.
Narcolepsy is a lifetime condition that requires ongoing
					 monitoring and assessment, as response to medications may wane over time, or
					 cataplexy may develop years after other symptoms. Given that daytime sleepiness
					 can be profound, careful monitoring for increasing levels of sleepiness and
					 emergence of cataplexy are essential. An overnight polysomnogram with multiple
					 sleep latency test (MSLT)i is recommended for
					 diagnosis. Practice parameters recommend regular follow up to determine
					 adherence and response to treatment; a patient stabilized on medications should
					 be seen regularly; at least once per year, and ideally twice
					 yearly.B Follow up MSLTi
					 or MWTii are not routinely performed, but may be
					 used to assess an individual's ability to remain awake (or propensity to fall
					 asleep) if sleepiness poses a risk for public or personal
					 safety.C
There are significant implications for driving safety given
					 the core symptoms of this condition but there is a paucity of data regarding
					 narcolepsy and driving safety. People with untreated symptoms of narcolepsy
					 have three to four-fold risk of crashes compared to the general population
					 (self-reported data).D, E, F The few studies that
					 examined crash risk and narcolepsy were performed in untreated individuals and
					 utilized driving simulators: the applicability to real world driving is not
					 known.G Narcolepsy is a treatable condition, and
					 both behavioral interventions and medications are used. Medications used to
					 treat sleepiness include but are not limited to stimulants
					 (amphetamine/methylphenidate), wake promoting (modafinil, armodfinil,
					 pitolisant) and sodium oxybate (Xyrem/Xyway). Cataplexy is treated with
					 medications such as Serotonin and Norepinephrine Reuptake Inhibitor/Selective
					 Serotonin Reuptake Inhibitor medications (SNRI/SSRI's), tricyclic
					 antidepressant medications, pitolisant, and/or sodium oxybate.
Narcolepsy with cataplexy may create increased risk for
					 unsafe driving. Given the risk for crashes if symptoms are not effectively
					 treated, clinician documentation should include additional information
					 regarding current symptoms that may impact safe operation of a motor vehicle.
					 Specifically, documentation should include the presence or absence and severity
					 of cataplexy, cataplexy triggers, degree of residual daytime sleepiness, and
					 adherence to medications and behavioral strategies.
Idiopathic hypersomnia is a sleep condition characterized
					 by chronic excessive sleepiness. Patients struggle to maintain wakefulness
					 during the day, with sleep occurring at inappropriate times and interfering
					 with daily activities. The diagnosis of idiopathic hypersomnia requires an
					 overnight polysomnography to rule out other possible etiologies such as
					 obstructive sleep apnea. This may be followed by a multiple sleep latency test
					 demonstrating a shortened sleep latency (< 8 minutes) and < 2 sleep-onset
					 REM periods which will help to differentiate from a narcolepsy
					 diagnosis.H Medications including stimulants and
					 wake promoting medications are often used to manage daytime
					 sleepiness.I
Footnotes:
iMultiple Sleep Latency Test:
					 performed in Sleep Centers. Objective determination of an individual's
					 underlying sleepiness by measuring latency to sleep in 5 trials of 20 minutes
					 each after documentation of adequate sleep the night prior to testing.
					 Pathologic sleepiness is defined as a mean sleep latency of less than 8
					 minutes. May be used to assess efficacy of
					 treatment.J
iiMaintenance of Wakefulness
					 Test: performed in Sleep Centers. Objective assessment of ability to stay awake
					 while passive and sedentary in a non-stimulating environment. The strongest
					 evidence for an individual's ability to maintain wakefulness is provided by a
					 capacity to remain awake through 4 trials of 40 minutes each. AASM standards
					 state that MWT testing is indicated when assessing individuals whose inability
					 to remain alert constitutes a safety hazard and in patients with Narcolepsy.
					 May be used to assess efficacy of treatment.K
FUNCTIONAL ABILITY PROFILE
Narcolepsy or Idiopathic
					 Hypersomnia1
Profile Levels
Degree of Impairment/Potential for At Risk
								Driving
Condition Definition / Example
Interval for Review and Other
								Actions
1.
No diagnosed condition
No diagnosed narcolepsy or idiopathic
								hypersomnia.
N/A
2.
Condition fully recovered
Narcolepsy is a chronic lifelong condition.
Do not use this profile level for
								narcolepsy.
3.
Active impairment
(Profile levels are intended to describe potential
								for at risk driving; they are NOT consistent with clinical definitions for
								mild, moderate or severe.)
This diagnosis must be made by a physician,
								(preferably a sleep specialist, neurologist or pulmonologist), or nurse
								practitioners and physicians assistants with specialized training in
								narcolepsy.
This FAP applies to patients who have a confirmed
								diagnosis of narcolepsy or idiopathic hypersomnia. (For exception, see profile
								level 3c.)
Clinician assessment recommended at least
								annually.
Clinician should assess risk, evaluating the
								presence/absence of cataplexy (type of symptoms and frequency), cataplexy
								triggers, effectiveness of treatment, and adherence to treatment.
a. Mild risk
No recent crashes or near misses due to sleepiness
								or cataplexy, and
Mild subjective sleepiness (Epworth Sleepiness
								Scale2 of 12 or less), and
Consistent use of medications and behavioral
								strategies, and
No cataplexy, or predictable mild cataplexy that
								does not cause risk for driving and is controlled with behavioral strategies
								and medication.
2 year
b. Moderate risk
No recent crashes or near misses due to sleepiness,
								and
Moderate subjective sleepiness
								(ESS2 13-15), and
Consistent use of medications and behavioral
								strategies for sleepiness, and avoidance of driving if sleepy, and
No cataplexy or predictable mild cataplexy that
								does not cause risk for driving and is controlled with behavioral strategies
								and medication.
1 year
c. Severe risk
Recent crash or near miss due to sleepiness or
								cataplexy; or
Uncontrolled narcolepsy; or
Inconsistent use of medications or no effective
								medication yet found; or
Severe subjective sleepiness
								(ESS2 16 or higher); or
Unpredictable cataplexy or cataplexy that poses
								risk for driving; or
Suspected narcolepsy under investigation with
								concern for safety.
No driving
1 For further discussion
					 regarding NARCOLEPSY OR IDEOPATHIC HYPERSOMNIA, please refer to PREAMBLE at the
					 beginning of this section.
2 The Epworth Sleepiness Scale
					 is a widely used measure of subjective daytime sleepiness. It is a validated
					 sleep questionnaire containing eight items that ask for self-reported
					 disclosure of expectation of "dozing" in a variety of situations. Dozing
					 probability ratings are none (0), slight (1), moderate (2), or high (3) in
					 eight hypothetical situations. A scale of 0-10 is normal, 11-12 is mild, 13-15
					 is moderate, and 16-24 is severe excessive daytime sleepiness.
https://epworthsleepinessscale.com/about-the-ess/
.
OTHER MEDICAL PREAMBLE
The Medical Advisory Board recognizes that not all patients
					 fit into one of the diagnostic categories outlined in the Functional Ability
					 Profile (FAP) rules. The category of Medical-Other has been created to
					 encompass drivers with conditions not included in other specified FAP
					 categories, especially when there are multiple medical or fluctuating medical
					 problems that may negatively impact ability to drive safely. Examples may
					 include recurring hepatic encephalopathy, symptoms associated with renal
					 failure and dialysis, brain cancer, or others.
The evaluating clinician should use this profile only when
					 one of the other listed categories does not adequately capture the clinician's
					 concerns
and
when there are specific concerns for unsafe operation
					 of a motor vehicle. The clinician should
include a narrative
					 description of the medical concerns and their impact on driving
when
					 submitting a Driver Medical Evaluation (CR-24 form).
This FAP excludes
conditions addressed in
					 other FAP's. Please note that generalized deconditioning can be addressed using
					 the Miscellaneous Musculoskeletal and/or Neurological Conditions FAP. Concerns
					 related to polypharmacy may be addressed using the FAP for Prescription
					 Medications and/or Opioid Replacement Therapy.
FUNCTIONAL ABILITY PROFILE
Other
					 Medical1
Profile Levels
Degree of Impairment/Potential for At Risk
								Driving
Condition Definition / Example
Interval for Review and Other
								Actions
1.
No diagnosed condition
No known disorder
N/A
2.
Condition fully recovered
Condition is recovered with no on-going risk for
								unsafe driving.
N/A
3.
Active impairment
(Profile levels are intended to describe potential
								for at risk driving; they are NOT consistent with clinical definitions for
								mild, moderate or severe.)
A condition or combination of conditions that poses
								risk for unsafe driving but is not included in any other specified FAP
								category.
Requires diagnosis and description of
								concerns
a. Mild risk
Condition warrants review for impact on
								driving.
A medical concern with fluctuating symptoms that
								could impair driving; or
Multiple medical problems that together may impair
								ability to drive safely; or A condition that could impair driving but is not
								included in any other specified FAP category.
2 years or as recommended by clinician
b. Moderate risk
Condition may require more frequent medical review,
								or may require use of personal assistive medical
								devices,2 adaptive driving aids for the vehicle,
								driving restrictions or a road test;3 and/or
A medical condition with fluctuating symptoms; or
								multiple medical problems; or a condition not listed in any other FAP category;
								and condition could impair driving.
1 year or as recommended by clinician Road
								test3 may be recommended by clinician.
c. Severe risk
A medical condition not included in any other
								specified FAP category that presently impairs skills needed for safe driving.
								This may be due to severity of the condition; because the condition is not
								controlled; due to treatment side effects or because condition requires further
								evaluation to determine safety to drive.
No driving Specific impairment must be
								described.
No driving will be allowed until a new Driver
								Medical Evaluation form is completed, detailing resolution of condition.
1 For further discussion
					 regarding OTHER MEDICAL, please refer to Preamble at the beginning of this
					 section.
2 Personal assistive medical
					 devices include but are not limited to a wheelchair, prosthesis, orthosis,
					 walker, or a cane when required for normal ambulation.
3 Refer to the appendix for more
					 information about BMV Road Tests and/or a Comprehensive Occupational Therapy
					 Driving Evaluation. On-road tests with a driving rehabilitation instructor,
					 occupational therapist or a driver educator may be appropriate in some
					 situations, but BMV does not normally require these evaluations and they are
					 not a substitute for a BMV road test.
PRESCRIPTION MEDICATIONS &/or OPIOID REPLACEMENT
					 THERAPY PREAMBLE
Prescription medications, even when taken as prescribed,
					 have the potential for side effects,
1
dependence, or interactions which may alter the ability to drive, or exacerbate
					 a decline in function related to an underlying medical condition. It is
					 important for clinicians to know that a driver who is impaired due to
					 prescribed medication or medical marijuana can also be charged with OUI.
Clinicians are responsible to assess their patients for
					 potential risks and advise them whether to drive or not based on their
					 medications and medical conditions. With this in mind, the clinician's role is
					 to recognize high-risk individuals from a medical perspective and assess their
					 physical and mental fitness to drive safely.
Normally, BMV does not require reporting when
					 prescribed medications are used as ordered.
However, in cases where
					 proper use of prescription medications has resulted in driver impairment,
					 leading to OUI, crashes, reports of unsafe driving, or when a clinician is
					 concerned that a patient may be non-compliant with driving recommendations, use
					 of the Prescription Medications and/or Opioid Replacement FAP is
					 appropriate.
This FAP may be used when there is a specific concern for
					 driving with a person on prescription medications, including prescribed opioid
					 medications for replacement therapy or pain management, or any other
					 medications that may potentially impair driving. Medications of particular
					 concern for driving include the tricyclic antidepressants, sedative hypnotics,
					 some antipsychotics, and benzodiazepines. Concern is even greater when patients
					 are prescribed more than two medications or are concurrently prescribed
					 opioids, using medical marijuana, or are misusing drugs or alcohol. Methadone
					 and benzodiazepines are a particularly troubling combination for risk of
					 sedation. Data on buprenorphine and driving indicate that once established on a
					 dose and in stable recovery, most people can safely drive. This must be
					 assessed on an individual basis.A Medical Marijuana,
					 although not a prescription medication, is included here due to its' potential
					 to produce side effects that could impair driving.
Statistically, once a patient is on an established dose of
					 methadone, the risk for sedation or at-risk driving is minimal (barring any
					 other polysubstance abuse or polypharmacy).B
					 However, on an individual basis, in the period of time immediately following an
					 opioid replacement dose, there may be an increased risk for sedation to the
					 point that the patient should be counseled not to drive. This is particularly
					 pertinent in the case of methadone, since patients may have to drive to receive
					 a dose at a methadone clinic and then drive home and is especially worrisome if
					 the patient is also on a benzodiazepine.
1
Physical
					 dependence occurs when a person develops a physiologic tolerance to a substance
					 or substances. Physical dependence on a prescribed medication when taken as
					 ordered does not create concern for driving in and of itself. Be aware that
					 many patients who exhibit "drug-seeking" behaviors are likely exhibiting
					 physical dependence (which may be iatrogenic from legitimate treatment by the
					 medical provider).
FUNCTIONAL ABILITY PROFILE
Prescription Medications and/or Opioid Replacement
					 Therapy 
					 1
Profile Levels
Degree of Impairment/ Potential for At Risk
								Driving
Condition Definition / Example
Interval for Review and Other
								Actions
1.
No known disorder
No known history of unsafe driving due to
								prescribed medications.
N/A
2.
Condition fully recovered
No longer on opiate replacement therapy, with no
								relapses and no evidence of prescription abuse for at least 2
								years;2 or
No longer prescribed the medication(s) that caused
								impairment or no on-going side effects that could impair driving x 1
								year.2
N/A
3.
Active
								impairment3
(Profile levels are intended to describe potential
								for at risk driving; they are NOT consistent with clinical definitions for
								mild, moderate or severe.)
On prescription
								medication,3 or
On opioid replacement therapy, (e.g., suboxone or
								methadone or similar prescription), when there is a specific concern for
								driving; and
a. Mild risk
Stable and functioning well with no other Substance
								Use Disorder issues2 and no sedation or unsafe side
								effects. No impairment of motor, judgment or intellectual functions from
								prescription medications; or
Off prescription medications but not long enough to
								meet criteria for Profile Level 2.2
2 years
b. Moderate risk
Experiences sedating or other side effects from
								medication, but with judgment to avoid driving while having these side effects,
								and no other Substance Use Disorder issues.2
NOTE: If there is a history of poor judgment about
								driving under these circumstances, leading to OUI, crashes, or reports of
								unsafe driving, must demonstrate they have the judgment to avoid driving while
								having these side effects or have been off medication for at least 3 months AND
								passed a ROAD TEST, to resume driving.
1 year ROAD TEST
c. Severe risk
i. Experiences sedation or side effects from
								medication2, with poor judgment about driving under
								these circumstances, leading to OUI, crashes or reports of unsafe driving and
								has not yet met criteria for Profile Level 3.b; or
No driving
ii. Has problems with substances of abuse that
								increase the risk for dangerous driving in combination with prescription
								medications.2
Comply with appropriate profile level on Substance
								Use Disorder FAP
1 For further discussion
					 regarding PRESCRIPTION MEDICATIONS AND/OR OPIOID REPLACEMENT THERAPY, please
					 refer to Preamble at the beginning of this section.
2 Comply with "Substance Use
					 Disorders" FAP when patient misuses prescription medications or non-prescribed
					 drugs.
3 Normally, prescribed
					 medications used as ordered do not need to be reported to BMV. Clinicians are
					 responsible to assess their patients for potential risk and advise them whether
					 to drive or not based on their medications and medical conditions. However, in
					 cases where proper use of prescription medications has resulted in driver
					 impairment, such as OUI, crashes, reports of unsafe driving, or when a
					 clinician is concerned that a patient may be non-compliant with driving
					 recommendations, use of this FAP is appropriate.
SEIZURES AND EPILEPSY PREAMBLE
A seizure is a disruption in the normal electrical activity
					 in the brain resulting in temporary cerebral dysfunction. Epilepsy is defined
					 as a disorder in which a person has had two or more unprovoked seizures.
					 Epilepsy excludes people with provoked (otherwise known as symptomatic)
					 seizures such as from eclampsia, central nervous system infection, secondary to
					 an adverse drug reaction, acute stroke, metabolic derangement, or alcohol
					 withdrawal. Seizures and epilepsy shall be evaluated using this FAP. The
					 disorders causing provoked seizures as well as many other physiological
					 processes may cause an alteration in consciousness sufficient to preclude the
					 safe operation of a motor vehicle. These shall abide by the FAP in the
					 appropriate section if known, or that entitled, "Unexplained Alteration or Loss
					 of Consciousness".