The Louisiana CDL Physical Form is a critical document used to assess the physical fitness of commercial drivers in accordance with Department of Transportation requirements. This form collects essential health information and medical history to ensure that drivers can safely operate commercial motor vehicles. For those needing to complete this examination, fill out the form by clicking the button below.
The Louisiana CDL Physical Examination Form is a crucial document for commercial drivers seeking to obtain or renew their Commercial Driver's License (CDL). This form ensures compliance with Department of Transportation regulations, assessing the physical and mental fitness of drivers to operate commercial vehicles safely. It includes sections for driver information, health history, and a thorough medical examination. Drivers must provide personal details such as name, address, and Social Security number, along with a comprehensive health history that covers any medical conditions or medications that may affect their driving ability. The medical examiner conducts various tests, including vision and hearing assessments, as well as blood pressure and pulse rate measurements. Additionally, the form requires a urinalysis to check for any underlying health issues. The medical examiner's evaluation determines if the driver meets the necessary health standards to operate a commercial motor vehicle, with the possibility of issuing a medical certificate valid for up to two years, depending on the driver's health status. This process is vital not only for the safety of the driver but also for the safety of others on the road.
Louisiana Department of Public Safety & Corrections
Office of Motor Vehicles
CDL PHYSICAL EXAMINATION FORM
(Meets Department of Transportation Requirements)
Date of Examination: _____________
New Certification
Re-certification
Follow up
1. DRIVER’S INFORMATION: Driver completes this section.
Driver’s Name: ______________________________________________________________________________________________________
Address: ___________________________________________________________________________________________________________
Soc. Sec. No. ___________________________________ Date of Birth _____________________ Age ___________ Race/Sex ____________
Driver’s License No. _______________________ Class ______ State ______ Telephone: ___________________________________________
2. HEALTH HISTORY: Driver completes this section, but medical examiner is encouraged to discuss with driver.
Yes No
Any illness or injury in last 5 years?
Diabetes or elevated blood sugar controlled by:
Head/Brain injuries, disorders or illnesses
diet
Seizures, epilepsy
pills
If yes, specify medication ____________________________
insulin
Eye disorders or impaired vision (except corrective lenses)
Nervous or psychiatric disorders, severe depression
Ear disorders, loss of hearing or balance
If yes, specify medication _____________________________
Heart disease or heart attack; other cardiovascular condition
Loss of or altered consciousness
Fainting, dizziness
Heart surgery (valve replacement/bypass, angioplasty,
Sleep disorders, pauses in breathing while asleep,
pacemaker)
daytime sleepiness, loud snoring
High blood pressure
Stroke or paralysis
If yes, specify medication ___________________________
Muscular disease
Missing or impaired hand, arm, foot, leg, finger or toe
Shortness of breath
Spinal injury or disease
Lung disease, emphysema, asthma, chronic bronchitis
Chronic low back pain
Kidney disease, dialysis
Regular, frequent alcohol use
Liver disease
Narcotic or habit forming drug use
Digestive problems
For any YES answer, indicate onset date, diagnosis, treating physician’s name and address, and any current limitations. List all medications (including over the counter medications) used regularly or recently.
I certify that the above information is complete and true. I understand that inaccurate, false or missing information may invalidate the examination and my Medical Examiner’s Certificate.
Driver’s Signature
Date
Medical Examiners’s Comments on Health History (The medical examiner must review and discuss with the driver any YES answers and potential hazards of medications including over-the-counter medications while driving. Should additional medical documentation from a treating physician be warranted prior to determining if the driver meets the minimum requirements, said documentation should become a part of his/her medical file which is maintained in your office.) Discussion with driver should be documented below.
Is the condition(s) likely to hamper the driver’s ability to control and/or safely operate a commercial motor vehicle? Yes
No
Does treatment/medication utilized cause any side affects that are likely to hamper the ability to control and/or safely operate a commercial motor
vehicle? Yes No
NAME: __________________________________________________
TESTING Medical examiner completes Section 3 through 7
3.VISION: Standard: At least 20/40 distance acuity (Snellen) in each eye with or without correction. At least 70 degree peripheral in horizontal meridian measured in each eye. The use of corrective lenses should be noted on the Medical Examiner’s Certification.
INSTRUCTIONS: When other than the Snellen chart is used, give test results in Snellen-comparable values. In recording distance vision, use 20 feet as normal. Report visual acuity as a ratio with 20 as numerator and the smallest type read at 20 feet as denominator. If the applicant wears corrective lenses, these should be worn while visual acuity is being tested. If the driver habitually wears contact lenses or intends to do so while driving, sufficient evidence of good tolerance and adaptation to their use must be obvious. Monocular drivers are not qualified.
Numerical reading must be provided:
ACUITY (Distance)
UNCORRECTED
CORRECTED
HORIZONTAL FIELD OF VISION
Can applicant recognize and distinguish
Right Eye
20/______
degrees
among traffic control signals and devices
Left Eye
showing standard red, green and amber
Both Eyes
colors? Yes
Applicant meets visual acuity requirement only when wearing:______ Corrective lenses
Monocular Vision?: Yes
Complete next line only if vision testing is done by an ophthalmologist or optometrist:
Date of Exam
Printed Name of Ophthalmologist/Optometrist
Signature
Telephone Number
License No/State of Issue
4.HEARING: Standard: a) Must first perceive forced whispered voice > 5 ft., with or without hearing aid, or b) average hearing loss in better ear < 40 dB.
Check if hearing aid used for tests.
Check if hearing aid required to meet standard
INSTRUCTIONS: To convert audiometric test results from ISO to ANSI, -14 dB from ISO for 500 Hz, -10 dB for 1,000 Hz, -8.5 Db for 2,000 Hz. To average, add the readings for 3 frequencies tested and divide by 3.
Numerical readings must be recorded.
A) Record distance from individual at which forced whispered voice can first be heard.
Right Ear _______ ft.
Left Ear _______ ft.
B) If audiometer is used, record hearing loss in decibels.
500 Hz
1000 Hz
2000 Hz
Average
(Acc. To ANSI Z24.5-1951)
Right Ear
______
Left Ear
5.BLOOD PRESSURE/PULSE RATE - Numerical readings must be recorded. Medical Examiner should take at least two readings to confirm BP.
Blood
Systolic
Diastolic
Pressure
Driver qualified if <140/90.
Pulse Rate: Regular Irregular
Record Pulse Rate:
Reading
Category
Expiration Date
Recertification
140-159/90-99
Stage 1
1 year
1 year if <140/90.
One-time certificate for 3
months if 141-159/91-99.
160-179/100-109
Stage 2
One-time certificate for 3 months.
1 year from date of exam if
< 140/90
>180/110
Stage 3
6 months from date of exam if <140/90
6 months if <140/90
NOTE: Medical Examiner should take at least 2 readings to confirm blood pressure prior to posting reading on this form.
NAME: ___________________________________________________
6. LABORATORY AND OTHER TEST FINDINGS Numerical readings must be recorded.
Urinalysis is required. Protein, blood or sugar in the urine may be an indication for further testing to rule out any underlying medical problems.
Sp. Gr.
Protein
Sugar
URINE SPECIMEN:
_______________
Other Tests (Describe and record) ______________________________________________________________________________________
7. PHYSICAL EXAMINATION Height: ____________ (inches) Weight: ____________ (lbs)
The presence of a certain condition may not necessarily disqualify a driver, particularly if the condition is controlled adequately and is not likely to worsen or is readily amendable to treatment. Even if a condition does not disqualify a driver, the medical examiner may consider deferring the driver temporarily. Also, the driver should be advised to take the necessary steps to correct the condition as soon as possible particularly if the condition, if neglected, could result in more serious illness that might affect driving.
Check YES if there are any abnormalities. Check NO if the body system is normal. Discuss any YES answers in detail in the space below and indicate whether it would affect the driver’s ability to operate a commercial motor vehicle safely. Enter applicable item number before each comment. If organic disease is present, note that it has been compensated for. See Instructions to the Medical Examiner for guidance.
BODY SYSTEM
CHECK FOR:
YES*
NO
1.
General appearance
Marked overweight, tremor, signs of alcoholism, problem drinking,
or drug abuse.
2.
Eyes
Pupillary equality, reaction to light, accommodation, ocular motility,
ocular muscle imbalance, extraocular movement, nystagmus,
exophthalmos, strabismus uncorrected by corrective lenses, retinopathy,
cataracts, aphakia, glaucoma, macular degeneration. Refer to a
specialist if appropriate.
3.
Ears
Scarring of the tympanic membrane, occlusion of external canal,
perforated eardrums.
4.
Mouth and Throat
Irremediable deformities likely to interfere with breathing or swallowing.
5.
Heart
Murmurs, extra sounds, enlarged heart, pacemaker, implantable
defibrillator.
6.
Lungs and chest,
Abnormal chest wall expansion, abnormal respiratory rate, abnormal
not including breast
breath sounds including wheezes or alveolar rates, impaired respiratory
examination
function, cyanosis. Abnormal findings on physical exam may require
further testing such as pulmonary tests and/or x-ray of chest.
7.
Abdomen and Viscera
Enlarged liver, enlarged spleen, masses, bruits, hernia, significant
abdominal wall muscle weakness.
8.
Vascular system
Abnormal pulse and amplitude, carotid or arterial bruits, varicose veins.
9.
Genito-urinary systems
Hernias.
10.
Extremities - Limbs
Loss or impairment of leg, foot, toe, arm, hand, finger. Perceptible limp,
impaired. Driver may
deformities, atrophy, weakness, paralysis, clubbing, edema, hypotonia.
be subject to SPE
Insufficient mobility and strength in lower limb to operate pedals properly.
certificate if otherwise
Insufficient grasp and prehension in upper limb to maintain steering
qualified.
wheel grip.
11.
Spine, other
Previous surgery, deformities, limitation of motion, tenderness
musculoskeletal
12.
Neurological
Impaired equilibrium, coordination or speech pattern; paresthesia,
asymmetric deep tendon reflexes, sensory or positional abnormalities,
abnormal patellar and Babinski’s reflexes, ataxia.
*Comments
NAME: ______________________________________________________
Note certification status here. See Instructions to the Medical Examiner for guidance.
I certify that ________________________________________________________________________________________________________
Name of Driver
Meets standards in 49 CRF 391.41-49; qualifies for 2 year certificate
Wearing corrective lenses
Wearing hearing aid
Does not meet standards
Accompanied by a______waiver/exemption
Skill Performance Evaluation (SPE) Certificate
Meets standards, but periodic evaluation required.
Driving within an exempt intra-city zone
Qualified by operation of 49 CFR 391.64
(vision or insulin dependent waiver program)
Due to ___________________________driver qualified only for:
3 months
6 months
Other
Temporarily disqualified due to (condition or medication): _____________________________________________________________
Return to medical examiner’s office for follow up on: ________________________________________________________________________
Name of medical examiner (print)
Signature of medical examiner
Address of medical examiner
Telephone number of medical examiner
If meets standards, complete a Medical Examiner’s Certificate (at the back of
this form) as stated in 49 CFR 391.43(h).
TO BE COMPLETED BY PATIENT
I hereby authorize and request the physician who has examined and whose signature appears above to release all information and findings contained herein to the Louisiana Department of Public Safety and Corrections. The Louisiana Department of Public Safety and Corrections can release this information to such individuals or groups as may be considered necessary and appropriate to determine my ability to safely operate a commercial motor vehicle.
Signature of Patient
OMV COMPLETES THIS SECTION
REVIEWED BY
DATE
FIELD OFFICE
APP. DATE
HEADQUARTER’S REVIEW
49 CFR 391.41
Physical Qualifications for Drivers
THE DRIVER’S ROLE
Responsibilities, work schedules, physical and emotional demands, and lifestyles among commercial drivers vary by the type of driving that they do. Some of the main types of drivers include the following: turn around or short
relay (drivers return to
their home base each
evening); long relay
(drivers drive 9-11 hours and
then have at least a
10
hour off-duty period),
straight through haul
(cross country drivers); and
team drivers (drivers
share the driving by
alternating their 5-hour driving periods and 5-hour rest periods).
The following factors may be involved in a driver’s performance of duties: abrupt schedule changes and rotating work schedules, which may result in irregular sleep patterns and a driver beginning a trip in a fatigued condition; long hours; extended time away from family and friends, which may result in lack of social support; tight pickup and delivery schedules, with irregularity in work, rest, and eating patterns, adverse road , weather and traffic conditions, which may cause delays and lead to hurriedly loading or unloading cargo in order to compensate for the lost time; and environmental conditions such as excessive vibration, noise, and extremes in temperatures. Transporting passengers or hazardous materials may add to the demands on the commercial driver.
There may be duties in addition to the driving task for which a driver is responsible and needs to be fit. Some of these responsibilities are: coupling and uncoupling trailer(s) from the tractor; loading and unloading trailer(s) (sometimes a driver may lift a heavy load or unload as much as 50,000 pounds of freight after sitting for a long period of time without any stretching period); inspecting the operating condition of tractor and trailer(s) before, during, and after delivery of cargo; lifting, installing and removing heavy tire chains; and lifting heavy tarpaulins to cover open top trailers. The above tasks demand agility, the ability to bend and stoop, the ability to maintain a crouching position to inspect the underside of the vehicle, frequent entering and exiting of the cab, and the ability to climb ladders on the tractor and/or trailer(s).
In addition, a driver must have the perceptual skill to monitor a sometimes complex driving situation, the judgment skills to make quick decisions, when necessary, and the manipulative skills to control an oversize steering wheel, shift gears using a manual transmission, and maneuver a vehicle in crowded areas.
391.41PHYSICAL QUALIFICATION FOR DRIVERS
a)A person shall not drive a commercial motor vehicle unless he is physically qualified to do so
and, except as provided in 391.67, has on his person the original, or a photographic copy, of a medical examiner’s certificate that he is physically qualified to drive a commercial motor vehicle.
b)A person is physically qualified to drive a motor vehicle if that person:
1)Has no loss of a foot, a leg, a hand, or an arm, or has been granted a Skill Performance Evaluation (SPE) Certificate (formerly Limb Waiver Program) pursuant to 391.49.
2) Has no impairment of; (i) A hand or finger which interferes with prehension or power grasping; or (ii) An arm, foot, or leg which interferes with the ability to perform normal tasks associated with operating a commercial motor vehicle; or any other significant limb defect or limitation which interferes with the ability to perform normal tasks associated with operating a commercial motor vehicle; or has been granted a SPE Certificate pursuant to 391.49.
3) Has no established medical history or clinical
diagnosis of diabetes mellitus currently requiring insulin for control;
4)Has no current clinical diagnosis of myocardial infarction, angina pectoris, coronary insufficiency, thrombosis, or any other cardiovascular disease of a variety known to be accompanied by syncope, dyspnea, collapse, or congestive cardiac failure.
5)Has no established medical history or clinical diagnosis of a respiratory dysfunction likely to interfere with his ability to control and drive a commercial motor vehicle safely.
6)Has no current clinical diagnosis of high blood pressure likely to interfere with his ability to operate a commercial motor vehicle safely.
7)Has no established medical history or clinical diagnosis of rheumatic, arthritic, orthopedic, muscular, neuromuscular, or vascular disease which interferes with his ability to control and operate a commercial motor vehicle safely.
8)Has no established medical history or clinical diagnosis of epilepsy or any other condition which is likely to cause loss of consciousness or any loss of ability to control a commercial motor vehicle.
9)Has no mental, nervous, organic, or functional disease or psychiatric disorder likely to interfere with his ability to drive a commercial motor vehicle safely.
10)Has distant visual acuity of at least 20/40 (Snellen) in each eye without corrective lenses or visual acuity separately corrected to 20/40 (Snellen) or better with corrective lenses, distant binocular acuity of at least 20/40 (Snellen) in both eyes with or without corrective lenses, field of vision of at least 70 degrees in the horizontal meridian in each eye, and the ability to recognize the colors of traffic signals and devices showing standard red, green and amber.
11) First perceives a forced whispered voice in the better ear not less than 5 feet with or without the use of a hearing aid, or, if tested by use of an audiometric device, does not have an average hearing loss in the better ear greater than 40 decibels at 500 Hz, 1,000 Hz, and 2,000 Hz with or without a hearing aid when the audiometric device is calibrated to American National Standard (formerly ASA Standards) 224.5-1951.
12)(i) Does not use a controlled substance identified in 21 CFR 1308.11 Schedule I, an amphetamine, a narcotic, or any other habit-forming drug. (ii) Exception: A driver may use such a substance or drug, if the substance or drug is prescribed by a licensed medical practitioner who:
(A)Is familiar with the driver’s medical history and assigned duties; and (B) has advised the driver that the prescribed substance or drug will not adversely affect the driver’s ability to safely operate a commercial motor vehicle.
13) Has no current clinical diagnosis of alcoholism. For further information, see INSTRUCTIONS TO MEDICAL EXAMINER included in this form.
INSTRUCTIONS TO THE MEDICAL EXAMINER
General Information
The purpose of this examination is to determine a driver’s physical qualification to operate a commercial motor vehicle (CMV) in interstate commerce according to the requirements in 49 CFR 391.41-49. Therefore, the medical examiner must be knowledgeable of these requirements and guidelines developed by the FMCSA to assist the medical examiner in making the qualification determination. The medical examiner should be familiar with the driver’s responsibilities and work environment and is referred to the section on the form. The Driver’s Role.
In addition to reviewing the Health History section with the driver and conducting the physical examination, the medical examiner should discuss common prescriptions and over-the-counter medications relative to the side effects and hazards of these medications while driving. Educate driver to read warning labels on all medications. History of certain conditions may be cause for rejection, particularly if required by regulation, or may indicate the need for additional laboratory tests or more stringent examinations perhaps by a medical specialist. These decisions are usually made by the medical
examiner in light of the driver’s job responsibilities, work schedule and potential for the condition to render the driver unsafe.
Medical conditions should be recorded even if they are not cause for denial, and they should be discussed with the driver to encourage
appropriate remedial care. This advice is especially needed when a condition, if neglected, could develop into a serious illness that could affect driving.
If the medical examiner determines that the driver is fit to drive and is also able to perform non-driving responsibilities as may be required, the medical examiner signs the medical certificate which the driver must carry with his/her license. The certificate must be dated. Under current regulations, the certificate is valid for 2 years, unless the driver has a medical condition that does not prohibit driving but does require more frequent monitoring. In such situations, the medical certificate should be issued for a shorter length of time. The physical examination should be done carefully and at least as complete as indicated by the attached form. Contact the FMCSA at (202) 366-1790 for further information (a vision exemption, qualifying drivers under 49 CFR 391.64, etc).
Interpretation of Medical Standards
Since the issuance of the regulations for physical qualifications for commercial drivers, the Federal Motor Carrier Safety Administration (FMCSA) has published recommendations called Advisory Criteria to help medical examiners in determining whether a driver meets the physical qualifications for commercial driving. These recommendations have been condensed to
provide information to medical examiners that (1) is directly relevant to the physical examination and
(2)is not already included in the medical examination form. The specific regulation is printed in italics and its reference by section is highlighted.
Federal Motor Carrier Safety Regulations
-Advisory Criteria-
Loss of Limb: 391.41(b)(1)
A person is physically qualified to drive a commercial motor vehicle if that person:
Has no loss of a foot, leg, hand or an arm, or has been granted a Skill Performance Evaluation (SPE) Certificate pursuant to Section 391.49.
Limb Impairment: 391.41(b)(2)
A person is physically qualified to drive a commercial motor vehicle if that person: Has no i m p a i r m e n t o f . , ( i ) A h a n d o r f i n g e r w h i c h interferes with prehension or power grasping; or
(ii)An arm, foot, or leg which interferes with the ability to perform normal tasks associated with operating a commercial motor vehicle; or (iii) Any other significant limb defect or limitation which interferes with the ability to perform normal tasks associated with operating a commercial motor vehicle; Perform normal tasks associated with operating a commercial motor vehicle; or (iv) Has been granted a Skill Performance Evaluation Certificate pursuant to Section 391.49.
A person who suffers loss of a foot, leg, hand or arm or whose limb impairment in any way interferes with the safe performance of normal tasks associated with operating a commercial motor vehicle is subject to the Skill Performance Evaluation (SPE) Certification Program pursuant to Section 391 . 49, assuming the person is otherwise qualified.
With the advancement of technology, medical aids and equipment modifications have b e e n d e v e l o p e d t o c o m p e n s a t e f o r c e r t a i n
disabilities . The SPE Certification Program (formerly the Limb Waiver Program) was designed to allow persons with the loss of a foot or limb or with functionai impairment to qualify under the Federal Motor Carrier Safety Regulations (FMCSRs) by use of prosthetic devices or equipment modifications which enable them to safely operate a commercial motor vehicle. Since there are no medical aids equivalent to the original body or limb, certain risks are still present, and thus restrictions may be included on individual SPE certificates when a State Director for the FMCSA determines they are necessary to be consistent with safety and public interest.
If the driver is found otherwise medically qualified (391.41(b)(3) through (13)), the medical examiner must check on the medical certificate that the driver is qualified only if accompanied by a SPE certificate. The driver and the employing motor carrier are subject to appropriate penalty if the driver operates a commercial motor vehicle in interstate or foreign commerce without a current SPE certificate for his/her physical disability.
Diabetes: 391.41(b)(3)
Has no established medical history or clinical diagnosis for diabetes mellitus currently requiring insulin for control.
Diabetes mellitus is a disease which, on occasion, can result in a loss of consciousness or disorientation in time and space. Individuals who require insulin for control have conditions which can get out of control by the use of too much or too little insulin, or food intake not consistent with the insulin dosage. Incapacitation may occur from symptoms of hyperglycemic or hypoglycemic reactions (drowsiness, semiconsciousness, diabetic coma or insulin shock).
The administration of insulin is, within itself, a complicated process requiring insulin, syringe, needle, alcohol sponge and a sterile technique. Factors related to long-haul commercial motor vehicle operations, such as fatigue, lack of sleep, poor diet, emotional conditions, stress, and concomitant illness, compound the dangers. The FMCSA has consistently held that a diabetic who uses insulin for control does not meet the minimum physical requirements of the FMCSRs.
Hypoglycemic drugs, taken orally, are sometimes prescribed for diabetic individuals to help stimulate natural body production of insulin. If the condition can be controlled by the use of oral medication and diet, then an individual may be qualified under the present rule. CMV drivers who do not meet the Federal diabetes standard may call
(202)366-1790 for an application for a diabetes exemption.
NOTE: See Conference Report on Diabetic Disorders and Commercial Drivers and Insulin - U sing Commercial Motor Vehicle Drivers at: http:// www.fmcsa.dot.gov/rulesregs/medreports.htm
Cardiovascular Condition: 391.41(b)(4)
A person is physically qualified to drive a commercial motor vehicle if that person: Has no current clinical diagnosis of myocardial infarction, angina pectoris, coronary insufficiency, thrombosis or any other cardiovascular disease of a variety known to be accompanied by syncope, dyspnea, collapse or congestive cardiac failure.
The term “has no current clinical diagnosis of” is specifically designed to encompass: “a clinical diagnosis of” (1) a current cardiovascular condition, or (2) a cardiovascular condition which has not fully stabilized regardless of the time limit. The term “known to be accompanied by” is defined to include: a clinical diagnosis of a cardiovascular disease (1) which is accompanied by symptoms of syncope, dyspnea, collapse or congestive cardiac failure; and/or (2) which is likely to cause syncope,
dyspnea, collapse or congestive cardiac failure. It is the intent of the FMCSRs to render unqualified a driver who has a current cardiovascular
disease which is accompanied by and/or likely to cause symptoms of syncope, dyspnea, collapse, or congestive cardiac failure. However, the subjective decision of whether the nature and severity of an individual’s condition will likely cause symptoms of cardiovascular insufficiency is on an individual basis and qualification rests with the medical examiner and the motor carrier. In those cases where there is an occurrence of cardiovascular insufficiency (myocardial infarction, thrombosis, etc.) it is suggested before a driver is certified that he/she have a normal resting and stress electrocardiogram (ECG), no residual complications and no physical limitations, and is taking no medication likely to interfere with safe driving.
Coronary artery bypass surgery and pacemaker implantation are remedial procedures and thus, not unqualifying. Implantable cardioverter defibrillators are disqualifying due to risk of syncope. Coumadin is a medical treatment which can improve the health and safety of the driver and should not, by its use, medically disqualify the commercial driver. The emphasis should be on the underlying medical condition(s) which require treatment and the general health of the driver. The FMCSA should be contacted at (202) 366-1790 for additional recommendations regarding the physical qualifications of drivers on coumadin.
NOTE: See Conference on Cardiac Disorders and
CommercialDriversat http://www.fmcsa.dot.gov/rulesregs/medreports.htm.
Respiratory Dysfunction: 391.41(b)(5)
Has no established medical history or clinical diagnosis of a respiratory dysfunction likely to interfere with ability to control and drive a commercial motor vehicle safely.
Since a driver must be alert at all times, any change in his/her mental state is in direct conflict with highway safety. Even the lightest impairment in respiratory function under emergency conditions (when greater oxygen supply is necessary for performance) may be detrimental to safe driving.
There are many conditions that interfere with oxygen exchange and may result in incapacitation, including emphysema, chronic asthma, carcinoma, tuberculosis, chronic bronchitis and sleep apnea. If the medical examiner detects a respiratory dysfunction, that in any way is likely to interfere with the driver’s ability to safely control and drive a commercial motor vehicle, the driver must be referred to a specialist for further evaluation and therapy. Anticoagulation therapy for deep vein thrombosis and/or pulmonary thromboembolism is not unqualifying once optimum dose is achieved, provided lower extremity venous examinations remain normal and the treating physician gives a favorable recommendation.
NOTE: See conference on pulmonary/respiratory
disorders and commercial drivers at: http://www.fmcsa.dot.gov/rulesregs/medreports.htm.
Hypertension: 391.41(b)(6)
Has no current clinical diagnosis of high blood pressure likely to interfere with ability to operate a commercial motor vehicle.
Hypertension alone is unlikely to cause sudden collapse; however, the likelihood increases when target organ damage, particularly cerebral vascular disease, is present. This regulatory criteria is based on FMCSA’s Cardiovascular Advisory Guidelines for the Examination of CMV Drivers, which used the Sixth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (1997).
Stage 1 hypertension corresponds to a systolic BP of 140-159mmHg and/or a diastolic BP of 90-99mmHg. The driver with a BP in this range is at low risk for hypertension-related acute incapacitation and may be medically certified to drive for a one-year period.
Certification examinations should be done annually thereafter and should be at or less than 140/90. If less than 160/100, certification may be extended one time for 3 months.
Ablood pressure of 160-179 systolic and/or 100-109 diastolic is considered Stage 2 hypertension, and the driver is not necessarily unqualified during evaluation and institution of treatment . The driver is given a one time certification of three months to reduce his or her blood pressure to less than or equal to 140/90. A blood pressure in this range is an absolute indication for anti-hypertensive drug therapy. Provided treatment is well tolerated and the driver demonstrates a BP value of 140/90 or less, he or she may be certified for one year from date of the initial exam . The driver is certified annually thereafter.
A blood pressure at or greater than 180 (systolic) and 110 (diastolic) is considered Stage 3, high risk for an acute BP-related event. The driver may not be qualified, even temporarily, until reduced to 140/90 or less and treatment is well tolerated. The driver may be certified for 6 months and biannually (every 6 months) thereafter if at recheck BP is 140/90 or less.
Annual recertification is recommended if the medical examiner does not know the severity of hypertension prior to treatment.
An elevated blood pressure finding should be confirmed by at least two subsequent measurements on different days.
Treatment includes nonpharmacologic and pharmacologic modalities as well as counseling to reduce other risk factors. Most antihypertensive medications also have side effects, the importance of which must be judged on an individual basis. Individuals must be alerted to
the hazards of these medications while driving. Side effects of somnolence or syncope are particularly undesirable in commercial drivers.
Secondary hypertension is based on the above stages. Evaluation is warranted if patient is persistently hypertensive on maximal or near- maximal doses of 2-3 pharmacological agents. Some causes of secondary hypertension may be amenable to surgical intervention or specific pharmacologic disease.
NOTE: See Cardiovascular Advisory Panel Guidelines for the Medical Examination of
Commercial Motor Vehicle Drivers at:
http://www.fmcsa.dot.gov/rulesregs/medreports.htm
Rheumatic, Arthritic, Orthopedic, Muscular, Neuromuscular or Vascular Disease: 391.41(b)(7)
Has no established medical history or clinical diagnosis of rheumatic, arthritic, orthopedic, muscular, neuromuscular or vascular disease which interferes with ability to control and operate a commercial motor vehicle safely
Certain diseases are known to have acute episodes of transient muscle weakness, poor
muscular coordination (ataxia), abnormal sensations (paresthesia), decreased muscular tone (hypotonia), visual disturbances and pain which may be suddenly incapacitating. With each recurring episode, these symptoms may become more pronounced and remain for longer periods of time. Other diseases have more insidious onsets and display symptoms of muscle wasting (atrophy), swelling and paresthesia which may not suddenly incapacitate a person but may restrict his/her movements and eventually interfere with the ability to safely operate a motor vehicle. In many instances these diseases are degenerative in nature or may result in deterioration of the involved area.
Once the individual has been diagnosed as having rheumatic, arthritic, orthopedic, muscular, neuromuscular or vascular disease, then he/she has an established history of that disease . The physician, when examining an individual, should consider the following: (1) the nature and severity of the individual’s condition (such as sensory loss or loss of strength); (2) the degree of limitation present (such as range of motion); (3) the likelihood of progressive limitation (not always present initially but may manifest itself over time); and (4) the likelihood of sudden incapacitation. If severe functional impairment exists, the driver does not qualify. In cases where more frequent monitoring is required, a certificate for a shorter time period may be issued.
NOTE: See Conference on Neurological Disorders
andCommercial Driversat: http://www.fmcsa.dot.gov/rulesregs/medreports.htm
Epilepsy: 391.41(b)(8)
Has no established medical history or clinical diagnosis of epilepsy or any other condition which is likely to cause loss of consciousness or any loss of ability to control a motor vehicle.
Epilepsy is a chronic functional disease characterized by seizures or episodes that occur without warning, resulting in loss of voluntary control which may lead to loss of consciousness and/or seizures. Therefore, the following drivers cannot be qualified: (1) a driver who has a medical history of epilepsy; (2) a driver who has a current clinical diagnosis of epilepsy; or (3) a driver who is taking anti-seizure medication.
If an individual has had a sudden episode of a non-epileptic seizure or loss of consciousness of unknown cause which did not require anti-seizure medication, the decision as to whether that person’s condition will likely cause loss of consciousness or loss of ability to control a motor vehicle is made on an individual basis by the medical examiner in consultation with the treating physician. Before certification is considered, it is suggested that a 6 month waiting period elapse from the time of the episode . Following the waiting period, it is suggested that the individual have a complete neurological examination. If the results of the examination are negative and anti - seizure medication is not required, then the driver may be qualified.
In those individual cases where a driver has a seizure or an episode of loss of consciousness that resulted from a known medical condition (e.g. drug reaction, high temperature, acute infectious disease, dehydration or acute metabolic disturbance), certification should be deferred until the driver has fully recovered from that condition and has no existing residual complications, and not taking anti-seizure medication.
D r i v e r s w i t h a h i s t o r y o f e p i l e p s y / seizures off anti-seizure medication and seizure-free for 10 years may be qualified to drive a CMV in interstate commerce. Interstate drivers with a history of a single unprovoked seizure may be qualified to drive a CMV and interstate commerce if seizure-free and off anti-seizure medication for a 5 year period or more.
andCommercialDrivers at: http://www.fmcsa.dot.gov/rulesregs/medreports.htm
Mental Disorders: 391.41(b)(9)
A person is physically qualified to drive a commercial motor vehicle if the person:
Has no mental, nervous, organic or functional disease or psychiatric disorder likely to interfere with the ability to drive a motor vehicle safely.
Emotional or adjustment problems contribute directly to an individual’s level of memory, reasoning, attention and judgment. These problems
often underlie physical disorders. A variety of functional disorders can cause drowsiness, dizziness, confusion, weakness or paralysis that may lead to incoordination, inattention, loss of functional control and susceptibility to accidents while driving. Physical fatigue, headache, impaired coordination, recurring physical, ailments and chronic “nagging” pain may be present to such a degree that certification for commercial driving is inadvisable. Somatic and psychosomatic complaints should be thoroughly examined when determining an individual’s overall fitness to drive. Disorders of a periodically incapacitating nature, even in the early stages of development, may warrant disqualification.
Many bus and truck drivers have documented that “nervous trouble” related to neurotic, personality, emotional or adjustment problems is responsible for a significant fraction of their preventable accidents. The degree to which an individual is able to appreciate, evaluate and adequately respond to environmental strain and emotional stress is critical when assessing an individual’s mental alertness and flexibility to cope with the stresses of commercial motor vehicle driving.
When examining the driver, it should be kept in mind that individuals who live under chronic emotional upsets may have deeply ingrained maladaptive or erratic behavior patterns. Excessively antagonistic, instinctive, impulsive, openly aggressive, paranoid or severely depressed behavior greatly interfere with the driver’s ability to drive safely. Those individuals who are highly susceptible to frequent states of emotional instability (schizophrenia, affective psychoses, paranoia, anxiety or depressive neuroses) may warrant disqualification. Careful consideration should be given to the side effects and interactions of medications in the overall qualification determination. See Psychiatric Conference Report for specific recommendations on the use of these medications and potential hazards for driving.
NOTE: See Conference on Psychiatric Disorders and
CommercialDriversat: http://www.fmcsa.dot.gov/rulesregs/medreports.htm
Vision: 391.41(b)(10)
Has distant visual acuity of at least 20/40 (Snellen) in each eye with or without corrective lenses or visual acuity separately corrected to 20/40 (Snellen) or better with corrective lenses, distance binocular acuity of at least 20/40 (Snellen) in both eyes with or without corrective lenses, field of vision of at least 70 degrees in the horizontal meridian in each eye, and the ability to recognize the colors of traffic signals and devices showing standard red, green and amber.
The term “ability to recognize the colors of” is interpreted to mean if a person can recognize and distinguish among traffic control signals and devices showing standard red, green and amber, he or she meets the minimum standards, even though he or she may have some type of color perception deficiency. If certain color perception tests are administered, (such as Ishihara, Pseudoisochromatic, Yarn) and doubtful findings are discovered, a controlled test using signal red, green and amber may be employed to determine the driver’s ability to recognize these colors.
Contact lenses are permissible if there is sufficient evidence to indicate that the driver has good tolerance and is well adapted to their use. Use of a contact lens in one eye for distance visual acuity and another lens in the other eye for near vision is not acceptable, nor are telescopic lenses acceptable for the driving of commercial motor vehicles.
If an individual meets the criteria by the use of glasses or contact lenses, the following statement shall appear on the Medical Examiner’s Certificate: “Qualified only if wearing corrective lenses”.
CMV drivers who do not meet the Federal vision standard may call (202) 366-1790 for an application for a vision exemption.
NOTE: See Visual Disorders and Commercial Drivers at: http://www.fmcsa.dot.gov/rulesregs/medreports.htm
Hearing: 391.41(b)(11)
First perceives a forced whispered voice in the better ear at not less than 5 feet with or without the use of a hearing aid, or, if tested by use of an audiometric device, does not have an average hearing loss in the better ear greater than 40 decibels at 500 Hz, 1,000 Hz, 2,000 Hz with or without a hearing aid when the audiometric device is calibrated to American National Standard (formerly ASA Standard) 224.5-1951
Since the prescribed standard under the FMCSRs is the American Standards Association (ANSI), it may be necessary to convert the audiometric results from the ISO standard to the ANSI standard. Instructions are included on the Medical Examination report form.
If an individual meets the criteria by using a hearing aid, the driver must wear that hearing aid and have it in operation at all times w h i l e d r i v i n g . A l s o , t h e d r i v e r m u s t b e i n possession of a space power source for the hearing aid.
For the whispered voice test, the individual should be stationed at least 5 feet from the examiner with the ear being tested turned toward the examiner. The other ear is covered. Using the breath which remains after a normal expiration, the examiner whispers words or random numbers such as 66, 18, 23, etc. The examiner should not use only sibilants (s-sounding test materials). The opposite ear should be tested in the same manner. If the individual fails the whispered voice test, the audiometric test should be administered.
If an individual meets the criteria by the use of a hearing aid, the following statement must appear on the Medical Examiner’s Certification “ Qualified only when wearing a hearing aid”.
NOTE: See Hearing Disorders and Commercial
M o t o rVe h i c l e D r i v e r s a t : http://www.fmcsa.dot.gov/rulesregs/medreports.htm
Drug Use 391.41(b)(12)
Does not use a controlled substance identified in 21 CFR 1308.11. Schedule 1, an amphetamine, a n a r c o t i c , o r a n y o t h e r h a b i t - f o r m i n g d r u g . Exception: A driver may use such a substance or drug, if the substance or drug is prescribed by a licensed medical practitioner who is familiar with the driver’s medical history and assigned duties; and has advised the driver that the prescribed substance or drug will not adversely affect the driver’s ability to safely operate a commercial motor vehicle.
This exception does not apply to methadone. The intent of the medical certification process is to medically evaluate a driver to ensure that the driver has no medical condition which interferes with the safe performance of driving tasks on a public road. If a driver uses a Schedule I drug or other substance, an amphetamine, a narcotic, or any other habit-forming drug, it may be cause for the driver to be found medically unqualified. Motor carriers are encouraged to obtain a practitioner’s written statement about the effects on transportation safety of the use of a particular drug.
A test for controlled substances is not required as part of this biennial certification process. The FMCSA or the driver’s employer should be contacted directly for information on controlled substances and alcohol testing under Part 382 of the FMCSRs.
The term “uses” is designed to encompass instances of prohibited drug use determined by a physician through established
medical means. This may or may not involve body fluid testing. If body fluid testing takes place, posi- tive test results should be confirmed by a second test of greater specificity. The term “habit-form- ing” is intended to include any drug or medi- cation generally recognized as capable of be- coming habitual, and which may impair the user’s ability to operate a commercial motor vehicle safely.
The driver is medically unqualified for the duration of the prohibited drug(s) use and until a second examination shows the driver is free from the prohibited drug(s) use. Re-certification may involve a substance abuse evaluation, the successful completion of a drug rehabilitation program, and a negative drug test result. Additionally, given that the certification period is normally two years, the examiner has the option to certify for a period of less than 2 years if this examiner determines more frequent monitoring is required.
NOTE: See Conference on Neurological Disorders and Commercial Drivers Conference on Psychiatric Disorders and Commercial Drivers at: http://fmcsa.dot.gov/rulesregs/medreport.htm
Alcoholism: 391.41(b)(13)
A person is physically
qualified to drive a commercial motor vehicle if that person:
Has no current clinical diagnosis of alcoholism.
The term “current clinical diagnosis of” is specifically designed to encompass a current alcoholic illness or those instances where the individual’s physical condition has not fully stabilized, regardless of the time element. If an individual shows signs of having an alcohol-use problem, he/ she should be referred to a specialist. After counseling and/or treatment, he or she may be considered for certification.
MEDICALEXAMINER’S CERTIFICATE
IcertifythatIhaveexamined____________________________________inaccordancewiththeFederalMotorCarrierSafetyRegulations(49CFR391.41-
391.49)andwithknowledgeofthedrivingduties,Ifindthispersonisqualified;and,ifapplicable,onlywhen:
wearingcorrectivelenses
drivingwithinanexemptintra-cityzone(49CFR391.62)
wearingahearingaid
accompaniedbyaSkillPerformanceEvaluation(SPE)Certificate
accompaniedbya
qualifiedbyoperationof49CFR391.64(visionorinsulindependent
waiver/exemption
waiverprogram)
TheinformationIhaveprovidedregardingthisphysicalexaminationistrueandcomplete. Acompleteexaminationformwithanyattachmentembodiesmy findingscompletelyandcorrectlyandisonfileinmyoffice.
DateofExamination
SignatureofMedicalExaminer
Telephone
ExpirationDateofDriverCertification
MD
DO
Chiropractor
PhysicianAsst.
AdvancedPracticeNurse
NameofMedicalExaminer(Print)
Medical Examiner’sAddress
MedicalExaminer’sLicense/Certificate#
IssuingState
SignatureofDriver
Driver’sLicenseNumber
StateofLicense
Driver’sName(Print)
Driver’sAddress (City/State/Zip)
NOTE: DRIVERMUSTCARRYACOPYOFTHISCERTIFICATEWHENOPERATINGACOMMERCIAL VEHICLE.
DPSMV 2219 (R/12/03)
Completing the Louisiana CDL Physical Examination Form is an essential step for those seeking to operate commercial motor vehicles. This form collects vital information regarding the driver's health history and physical capabilities, which will be evaluated by a medical examiner. After filling out the form, the driver will undergo a physical examination to determine their fitness for driving.
The Louisiana CDL Physical Examination Form is designed to assess whether a driver is physically qualified to operate a commercial motor vehicle. This form meets the requirements set by the Department of Transportation (DOT) and ensures that drivers are capable of safely managing the demands of their job. It includes sections for the driver's personal information, health history, vision and hearing tests, and a general physical examination. The goal is to identify any medical conditions that could impair a driver's ability to operate a vehicle safely.
The form must be completed by both the driver and a certified medical examiner. The driver is responsible for providing accurate personal and health information, including any medical conditions or medications that may affect their driving abilities. The medical examiner conducts a thorough examination, reviews the driver's health history, and assesses their physical fitness based on established DOT standards. It is crucial that both parties collaborate to ensure the information is complete and accurate.
If a driver discloses a medical condition on the form, the medical examiner will evaluate whether it affects the driver's ability to operate a commercial motor vehicle safely. Depending on the condition, the examiner may require additional documentation or tests from a treating physician. If the condition is manageable and does not impair driving ability, the driver may still qualify for a medical certificate. However, if the condition poses a significant risk, the driver may be temporarily disqualified or issued a certificate for a shorter duration, necessitating more frequent evaluations.
Drivers are typically required to complete the CDL Physical Examination Form every two years. However, if a driver has a medical condition that requires closer monitoring, the medical examiner may issue a certificate for a shorter period, such as six months or one year. It is essential for drivers to stay informed about their health and any changes that could affect their qualifications. Regular check-ups and open communication with medical professionals can help ensure that drivers maintain their ability to operate a commercial vehicle safely.
Inaccurate Personal Information: One common mistake is providing incorrect or incomplete personal details, such as the driver's name, address, or Social Security number. This can lead to delays or issues with certification.
Neglecting Health History: Failing to disclose relevant health history, including past illnesses or medications, can invalidate the examination. It's crucial to be thorough and honest in this section.
Omitting Medication Details: Many drivers forget to list all medications, including over-the-counter drugs. This omission can result in misunderstandings about their ability to drive safely.
Ignoring Vision and Hearing Standards: Some individuals may not realize the importance of meeting specific vision and hearing requirements. Not providing accurate test results can lead to disqualification.
Misunderstanding Blood Pressure Requirements: Drivers might overlook the need for multiple blood pressure readings. A single reading may not be sufficient to confirm their qualification.
Failure to Sign and Date: Lastly, neglecting to sign and date the form can result in the document being considered incomplete. This simple step is essential for the validity of the examination.
When applying for a Commercial Driver's License (CDL) in Louisiana, several documents and forms work in conjunction with the Louisiana CDL Physical Examination Form. These documents help ensure that drivers meet the necessary health and safety standards required for operating commercial vehicles. Below is a brief overview of five essential forms that are commonly used alongside the CDL Physical Form.
These forms collectively contribute to a thorough evaluation of a driver's health and safety qualifications. By ensuring that all necessary documentation is completed, drivers can help facilitate a smoother application process for their CDL and maintain safety on the roads.
The Louisiana CDL Physical Examination Form shares similarities with the Department of Transportation (DOT) Medical Examination Report Form. Both documents serve the purpose of assessing an individual's medical fitness to operate commercial vehicles. They require detailed health history, including information about past illnesses, medications, and any conditions that could impair driving ability. Both forms also mandate a physical examination by a certified medical examiner, ensuring that the driver meets specific health standards before being certified to drive commercially.
Another document that is comparable is the Federal Motor Carrier Safety Administration (FMCSA) Medical Examiner's Certificate. This certificate is issued upon successful completion of a medical examination, confirming that a driver meets the necessary health criteria to operate a commercial motor vehicle. Like the Louisiana CDL Physical Form, it includes critical information such as the driver's medical history, examination results, and any required follow-up actions. Both documents emphasize the importance of safety on the roads by ensuring that drivers are physically capable of handling the demands of their job.
The Commercial Driver's License (CDL) Application Form also bears similarities to the Louisiana CDL Physical Examination Form. While the application form focuses on the driver's qualifications and experience, it often requires proof of medical fitness, which is substantiated by the physical examination results. Both documents work together to ensure that only qualified individuals are granted the authority to operate commercial vehicles, ultimately promoting road safety and compliance with state regulations.
The Occupational Safety and Health Administration (OSHA) Medical Evaluation Questionnaire is another related document. This questionnaire is used to assess an employee's health in relation to specific job-related risks, similar to how the CDL Physical Examination Form evaluates a driver's health regarding their ability to operate a commercial vehicle safely. Both documents require a thorough review of medical history and current health status to identify any potential risks that could affect job performance.
Lastly, the Employee Health History Form utilized by many employers aligns closely with the Louisiana CDL Physical Examination Form. This form collects information about an employee's health history, including chronic conditions and medications. While it is generally used for workplace safety and health assessments, it shares the same goal of ensuring that individuals are fit for their roles. Both documents emphasize the importance of transparency regarding health issues that could impact an individual's ability to perform their job safely and effectively.
When filling out the Louisiana CDL Physical form, it is important to approach the process carefully. Here are some guidelines to follow:
Conversely, there are also things to avoid during this process:
Here are ten common misconceptions about the Louisiana CDL Physical form, along with explanations to clarify each point:
Understanding these misconceptions can help drivers navigate the CDL physical process with greater confidence and clarity.
Complete Driver Information: Ensure all sections of the driver information are filled out accurately, including name, address, social security number, and date of birth. This information is crucial for identification and record-keeping.
Health History Discussion: The driver should complete the health history section, but it is essential for the medical examiner to discuss any "yes" answers to understand potential health risks better.
Vision Requirements: Drivers must meet specific vision standards, including 20/40 acuity in each eye, with or without corrective lenses. The medical examiner should note any use of corrective lenses on the certification.
Hearing Standards: A driver must be able to perceive a forced whispered voice from at least five feet away or have an average hearing loss of less than 40 decibels in the better ear.
Blood Pressure Monitoring: The medical examiner should take at least two blood pressure readings to confirm results. Drivers are qualified if their blood pressure is below 140/90.
Laboratory Tests: A urinalysis is required, and any abnormalities such as protein, blood, or sugar in the urine may necessitate further testing.
Physical Examination Insights: The physical examination should be thorough. Any abnormalities noted should be discussed, especially if they could impact the driver's ability to operate a commercial vehicle safely.
Certification Validity: If the driver meets the standards, the medical examiner will issue a Medical Examiner’s Certificate valid for two years unless more frequent monitoring is required due to medical conditions.