Health History

Driver Completes and Signs — Medical Examiner Reviews and Comments

The driver is instructed to indicate either an affirmative or negative history for each statement in the health history by checking either the "Yes" or "No" box.

The driver is also instructed to provide additional information for "Yes" responses, including:

• Onset date.
• Diagnosis.
• Treating provider contact information.
• Any limitations resulting from a current or past medical condition.
• Medications used regularly or recently, including prescriptions, over-the-counter, and herbal supplements.

Verify the Driver Signs Medical Examination Report Form

By signing the Medical Examination Report form, the driver:

• Certifies that information is “complete and true.”
• Acknowledges that providing inaccurate or false information or omitting information could:
  • Invalidate the examination and any certificate issued based on it.
  • Result in the levy of a civil penalty against the driver under 49 U.S.C. 521(b)(2)(B).

The purpose of the health history is to obtain information relevant to detecting the presence of physical, mental, or organic conditions of such character and extent as to affect the ability of the driver to operate a commercial motor vehicle (CMV) safely.

  Regulations — You must review and discuss with the driver any "Yes" answers

For each "Yes" answer:

• Ask about history, diagnosis, treatment, and response to treatment.
• Explore underlying cause, precipitating events, and other pertinent facts.
• Obtain additional tests or consultations, as necessary, to adequately assess the medical fitness of the driver.
• Review and discuss driver response to treatment and medications currently or recently used, including over-the-counter medications, and discuss any potential effects and side effects that may interfere with driving. As needed, you should also educate the driver regarding drug interactions with other prescription and nonprescription drugs and alcohol.
• Write all information on the Medical Examination Report form.

For information on a specific medical condition, see Part IV - Physical Qualification Standards of this handbook. Use the 49 CFR 391.41(b) Standards Review to access Part IV chapters.

Recommendations — Questions that you may ask include:

Does the driver have:

• Symptoms that interfere with safe driving because of:
  • Frequency?
  • Duration?
  • Severity?
  • Rapid onset?
• Limitations that interfere with safe driving because of:
  • Degree of limitation present?
  • Likelihood of progressive limitation?
• Medications that when used have effects and side effects that interfere with driving ability, such as:
  • Visual disturbances.
  • Drowsiness.
  • Hypotension.
  • Behavioral changes.

In addition to the guidance provided in the section above, For each "Yes" answer, directions specific to each category in Column 1 are listed below. Feel free to ask other questions to help you gather sufficient information to make your qualification/disqualification decision.

Any illness or injury in the last 5 years

A driver must report any condition for which he/she is currently under treatment. The driver is also asked to report any illness/injury he/she has sustained within the last 5 years, whether or not currently under treatment.

For information on specific medical conditions, see Part IV of this handbook.

Head/brain injuries, disorders, or illnesses

Ask questions that help you determine if the driver has recurring episodes of illness or any residual physical, cognitive, or behavioral effects that interfere with the ability to safely operate a CMV.

Seizures, epilepsy

Ask questions to ascertain whether the driver has a diagnosis of epilepsy (two or more unprovoked seizures), or whether the driver has had one seizure. Gather information regarding type of seizure, duration, frequency of seizure activity, and date of last seizure.

REMEMBER: According to regulation, a driver with an established medical history or clinical diagnosis of epilepsy does not meet qualification standards and cannot be certified.

Eye disorders or impaired vision (except corrective lenses)

Ask about changes in vision, diagnosis of eye disorder, and diagnoses commonly associated with secondary eye changes that interfere with driving. Complaints of glare or near-crashes are driver responses that may be the first warning signs of an eye disorder that interferes with safe driving.

REMEMBER: The requirements for vision screening are regulatory.

Ear disorders, loss of hearing or balance

Ask about changes in hearing, ringing in the ears, difficulties with balance, or dizziness. Loss of balance while performing nondriving tasks can lead to serious injury of the driver.

REMEMBER: The requirements for screening for hearing loss are regulatory.

Heart disease or acute myocardial infarction, other cardiovascular conditions

Ask about history and symptoms of cardiovascular disease (CVD), syncope, dyspnea, congestive heart failure, angina, etc.

NOTE: If the driver reports symptoms consistent with undiagnosed CVD, you should refer the driver to a specialist for further evaluation prior to certification. If a driver reports current CVD, consult with the driver health care provider and obtain documentation prior to certification.

Heart surgery

Ask about history of heart surgery, bypass, valve replacement, pacemaker, angioplasty, and whether the driver has an implantable cardioverter defibrillator (ICD). Obtain heart surgery information, including such pertinent operative reports as copies of the original cardiac catheterization report, stress tests, worksheets, and original tracings, as needed, to adequately assess medical fitness for duty.

NOTE: If a driver gives a "Yes" answer to the question regarding heart surgery, obtain documentation from the cardiologist before certifying. Also, FMCSA medical guidelines recommend not to certify the driver who has an ICD, due to risk of syncope and gradual or sudden incapacitation while driving a CMV. This includes a dual pacemaker/ICD, even if the ICD has not been activated.

High blood pressure

Ask about the history, diagnosis, and treatment of hypertension. In addition, talk with the driver about his/her response to prescribed medications.

Hypertension alone is unlikely to cause sudden collapse. The likelihood increases, however, when there is target organ damage, particularly cerebral vascular disease. Recommending specific therapy is beyond the scope of the physical examination. As a medical examiner, though, you are concerned with the blood pressure response to treatment, and whether the driver is free of any effects or side effects that could impair job performance.

Muscular disease

Ask the driver about history, diagnosis, and treatment of musculoskeletal conditions, such as rheumatic, arthritic, orthopedic, and neuromuscular diseases. Does the diagnosis indicate that the driver is at risk for sudden, incapacitating episodes of muscle weakness, ataxia, paresthesia, hypotonia, or pain? Does the diagnosis indicate a degenerative process that over time will restrict movements and eventually interfere with the ability to safely operate a CMV?

NOTE: In addition to driving, CMV driver duties include such rigorous activity as coupling and uncoupling trailers, loading and unloading trailers, inspecting the vehicle, lifting, installing tire chains, climbing ladders, getting in and out of the cab, etc. Musculoskeletal diseases may adversely impact the CMV driver’s muscle strength and agility needed to perform these nondriving tasks.

Shortness of breath (SOB)

Ask what activities precipitate the episodes, nature, and characteristics of SOB. Does the driver experience SOB only with exertion or also when at rest?

NOTE: According to guidelines, many drivers may experience SOB while performing the nondriving aspects of their work (e.g., loading and unloading, etc.). However, most commercial drivers are not short of breath while driving their vehicles. SOB while driving should trigger a more detailed evaluation of the driver that can include consulting with an appropriate medical specialist.

In addition to the guidance provided in the section above, For each "Yes" answer, directions specific to each category in Column 2 are listed below. Feel free to ask other questions to help you gather sufficient information to make your qualification/disqualification decision.

Lung disease, emphysema, asthma, chronic bronchitis

Ask about emergency room visits, hospitalizations, supplemental use of oxygen, use of inhalers and other medications, risk of exposure to allergens, etc.

NOTE: Since a driver must be alert at all times, any change in mental state is in direct conflict with highway safety. Even the slightest impairment in respiratory function under emergency conditions (when greater oxygen supply is necessary for performance) may be detrimental to safe driving.

Kidney disease, dialysis

Ask about the degree and stability of renal impairment, ability to maintain treatment schedules, and the presence and status of any co-existing diseases.

REMEMBER: If the driver is on dialysis, he/she cannot drive.

Digestive problems

Refer to the guidance found in Regulations - You must review and discuss with the driver any "Yes" answers.

Diabetes or elevated blood glucose controlled by diet, pills, or insulin

Ask about treatment, whether by diet, oral medications, Byetta, or insulin.

REMEMBER: Drivers with insulin-treated diabetes mellitus who are otherwise qualified may apply for a Federal exemption. To do so, the medical examiner must complete the examination and check the following boxes:

• Meets standards but periodic monitoring required due to (write in: insulin treatment).
• One year.
• Accompanied by (write in: Federal Diabetes) waiver/exemption (circle: exemption).

Nervous or psychiatric disorders (e.g., severe depression)

Refer to the guidance found in Regulations - You must review and discuss with the driver any "Yes" answers.

Loss of or altered consciousness

Loss of consciousness while driving endangers the driver and the public. Your discussion with the driver should include cause, duration, initial treatment, and any evidence of recurrence or prior episodes of loss of or altered consciousness. You may, on a case-by-case basis, obtain additional tests and/or consultation to adequately assess driver medical fitness for duty.

In addition to the guidance provided in the section above, For each "Yes" answer, directions specific to each category in Column 3 are listed below. Feel free to ask other questions to help you gather sufficient information to make your qualification/disqualification decision.

Fainting, dizziness

Note whether the driver checked “Yes” due to fainting or dizziness.  Ask about episode characteristics, including frequency, factors leading to and surrounding an episode, and any associated neurologic symptoms (e.g., headache, nausea, loss of consciousness, paresthesia).

Sleep disorders, pauses in breathing while asleep, daytime sleepiness, loud snoring

Ask the driver about sleep disorders. Also ask about such symptoms as daytime sleepiness, loud snoring, or pauses in breathing while asleep. When indicated, you should screen for sleep disorders.

Stroke or paralysis

Note any residual paresthesia, sensory deficit, or weakness as a result of stroke and consider both time and risk for seizure.

Missing or impaired hand, arm, foot, leg, finger, toe

Determine whether the missing limb affects driver power grasping, prehension, or ability to perform normal tasks, such as braking, clutching, accelerating, etc.

NOTE: The Skilled Performance Evaluation (SPE) is designed for fixed deficits of the extremities and cannot be used for deficits caused by progressive disorders.

Spinal injury or disease

Refer to the guidance found in Regulations - You must review and discuss with the driver any "Yes" answers.

Chronic low back pain

Ask about the degree of pain. How does the pain affect the ability of the driver to perform driving and nondriving tasks? What does the driver do to alleviate pain? Does the treatment interfere with safe driving?

Regular, frequent alcohol use

Ask about driver consumption of alcohol, including quantity and frequency, or use such tools as the CAGE questionnaire to screen for possible alcohol-use problems. You should refer the driver who shows signs of a current alcoholic illness to a specialist.

Narcotic or habit-forming drug use

Explore the use of the medication, whether or not it is prescribed, and the medication’s effect on driver reaction time, ability to focus, and concentration. Ask whether the medication causes drowsiness, fatigue, or sleepiness.

NOTE: The medical examiner has the authority to disqualify a driver if he/she believes that the medication the driver is taking adversely impacts the ability to safely operate a CMV.

At a minimum, your comments should include:

• Nature of a positive history and the effect on driving ability.
• Discussion about medication and/or treatment effects and side effects that might interfere with driving ability.

Include a copy of any supplementary medical reports obtained to complete the health history.