Survey of Medical Examiners Who Certify the Physical Qualifications of Commercial Motor Vehicle (CMV) Drivers

FMCSA-Office of Policy and Program Development

OMB Control Number: 2126-XXXX
Expiration Date:
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information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2126-XXXX.
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Administration, MC-MMI, Washington, D.C. 20590.

SURVEY OF MEDICAL EXAMINERS WHO CERTIFY THE PHYSICAL QUALIFICATIONS OF
COMMERCIAL MOTOR VEHICLE (CMV) DRIVERS
Goal for Presenting this Survey:
The Federal Motor Carrier Safety Administration (FMCSA) recognizes the very important role medical
examiners play in ensuring the safety of our roads through CMV driver physical examinations.
Your Responses:
Responses to the following questions will provide the only data available regarding the decision
making and performance of medical examiners as well as medical examiner perceptions of difficulties
or uncertainties associated with the examination process.
Your survey responses are extremely important. After data analysis is completed, all links between
direct identifiers, including zip code, will be removed and destroyed so that all responses are
anonymous. Data will be housed on a secure server and will only be reported in the aggregate; that
is, only collective, rather than individual results, will be reported.

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1) Do you currently conduct FMCSA-DOT CMV driver physical examinations? (Please select one)
A. Yes
B. No
(If no,) This survey is intended for medical examiners currently conducting FMCSA-DOT CMV driver
physical examinations. As you are not conducting these examinations, you do not need to continue
with the survey at this time.
Thank you for your time.
2)
Which of the following is your profession? (Please select one)
A. Advanced Practice Nurse
B. Doctor of Chiropractic
C. Doctor of Osteopathic Medicine
D. Medical Doctor
E. Physician Assistant
F. Other
(If other,) This survey is intended for medical examiners currently conducting FMCSA-DOT CMV
driver physical examinations and who are from the following medical professions: advanced practice
nurses, doctors of chiropractic, doctors of osteopathic medicine, medical doctors, and physician
assistants. As you do not identify yourself as a member of one of these professional groups, you do
not need to continue with the survey at this time.
Thank you for your time.
(If yes, respondent begins survey with next question.)

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FMCSA-Office of Policy and Program Development

Section 1: Case Studies
Instructions
Six case descriptions of individuals presenting for FMCSA-DOT medical examinations will be
presented. Depending on your responses, you may be asked to respond to up to four questions.
These same questions are repeated for each case.

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Case 1
A 64-year-old male presents for FMCSA-DOT medical recertification with a post-operative full-duty
release from his orthopedist. He had a left total knee replacement 90 days ago and now has a range
of motion of 90-degrees flexion. He has COPD with an FEV1 of 69% and uses a Flovent (fluticasone)
inhaler and Proventil HFA (albuterol) inhaler as needed. A Snellen vision examination reveals 20/40
acuity in the right eye and 20/30 in the left eye without correction. His blood pressure is 139/89
mmHg. He has a hearing aide in the right ear and cannot hear a whisper at 5 feet. He can hear a
whisper from his left ear at 5 feet. The physical examination was otherwise unremarkable.
Questions
3)
Do you need to collect more information before making a decision? (Please select one)
A. Yes
B. No (skips to question 5)
4)
If you think more information is needed to make a decision, which of the following would you seek?
(Please select all that apply)
A. Diagnostic tests
B. Specialist’s evaluation
C. Medical records
D. Medication lists
5)
Which of the following is the most appropriate medical examiner decision in your opinion? (Please
select one)
A. Meets standards in 49 CFR 391.41; qualifies for 2 year certificate (skips to question 7)
B. Does not meet standards (skips to question 7)
C. Meets standards, but periodic monitoring required (e.g., 3 months, 6 months, 1 year, other)
D. Temporarily disqualified due to condition or medication (skips to question 7)
6)
If you think the driver should be qualified, but for a period less than two years, when would your
qualification decision expire (Please select a number between 1 and 23 in months)?

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Case 2
A 55-year-old male who is 5’ 10” tall and weighs 322 pounds presents for FMCSA-DOT examination.
He identifies on his health history that he snores loudly at night. He relates his wife states he
sometimes stops breathing at night. He denies day-time drowsiness, but he does say he will pull over
while driving to nap during the day. His primary care provider has recommended a sleep study. He
has had hypertension for five years with follow up every six months. He takes multiple medications for
hypertension and continues to have difficulty controlling his blood pressure in spite of recent
medication changes. His blood pressure is 140/92 mmHg today. His urine dipstick is negative for
glucose or blood, but a trace of protein was noted.
Questions
7)
Do you need to collect more information before making a decision? (Please select one)
A. Yes
B. No (skip to question 9)
8)
If you think more information is beneficial to make a decision, which of the following would you seek?
(Please select all that apply)
A. Diagnostic tests
B. Specialist’s evaluation
C. Medical records
D. Medication lists
9)
Which of the following is the most appropriate medical examiner decision in your opinion? (Please
select one)
A. Meets standards in 49 CFR 391.41; qualifies for 2 year certificate (skips to question 11)
B. Does not meet standards (skips to question 11)
C. Meets standards, but periodic monitoring required (e.g., 3 months, 6 months, 1 year, other)
D. Temporarily disqualified due to condition or medication (skips to question 11)
10)
If you think the driver should be qualified, but for a period less than two years, when would your
qualification decision expire (Please select a number between 1 and 23 in months)?

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Case 3
An established patient presents for FMCSA-DOT medical certification. He is a 40-year-old male who
had a mechanical aortic valve replacement at age 32. The driver is a nonsmoker with an otherwise
negative history. He currently sees a cardiologist for echocardiograms and evaluation annually. The
driver brings in a copy of his last echocardiogram with an ejection fraction of 57%. His medications
include daily Coumadin (warfarin) with monthly coagulation times by International Normalized Ratio
(INR) coordinated with his primary physician. The driver also brings in copies of his coagulation times
and the INR values have been therapeutic. The driver reports no history of bleeding and is negative
for pertinent symptoms. Physical findings include blood pressure 110/68 mmHg and pulse 68.
Physical examination was otherwise unremarkable other than an S4 gallop.
Questions
11)
Do you need to collect more information before making a decision? (Please select one)
A. Yes
B. No (skip to question 13)
12)
If you think more information is beneficial to make a decision, which of the following would you seek?
(Please select all that apply)
A. Diagnostic tests
B. Specialist’s evaluation
C. Medical records
D. Medication lists
13)
Which of the following is the most appropriate medical examiner decision in your opinion? (Please
select one)
A. Meets standards in 49 CFR 391.41; qualifies for 2 year certificate (skips to question 15)
B. Does not meet standards (skips to question 15)
C. Meets standards, but periodic monitoring required (e.g., 3 months, 6 months, 1 year, other)
D. Temporarily disqualified due to condition or medication (skips to question 15)
14)
If you think the driver should be qualified, but for a period less than two years, when would your
qualification decision expire (Please select a number between 1 and 23 in months)?

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Case 4
A 49-year-old male presents for a new FMCSA-DOT medical certification. He has no history of
hypertension, hyperlipidemia, or CAD. He has a history of insulin-treated diabetes mellitus for 33
years and he does not have a diabetes exemption. He is on Humalog (lispro) twelve units, twice a
day and 50 units of Lantus (glargine) at bedtime. His last insulin reaction occurred three years ago
and his HgbA1c was 6.2% one month ago. His last eye examination was reported as normal six
months ago. He had no microalbuminuria on his last physical one year ago. He keeps glucose
tablets in his personal vehicle and his glucometer records demonstrate daily blood sugars between
85 and 140 mg/dL.
Questions
15)
Do you need to collect more information before making a decision? (Please select one)
A. Yes
B. No (skip to question 17)
16)
If you think more information is beneficial to make a decision, which of the following would you seek?
(Please select all that apply)
A. Diagnostic tests
B. Specialist’s evaluation
C. Medical records
D. Medication lists
17)
Which of the following is the most appropriate medical examiner decision in your opinion? (Please
select one)
A. Meets standards in 49 CFR 391.41; qualifies for 2 year certificate (skips to question 19)
B. Does not meet standards (skips to question 19)
C. Meets standards, but periodic monitoring required (e.g., 3 months, 6 months, 1 year, other)
D. Temporarily disqualified due to condition or medication (skips to question 19)
18)
If you think the driver should be qualified, but for a period less than two years, when would your
qualification decision expire (Please select a number between 1 and 23 in months)?

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FMCSA-Office of Policy and Program Development

Case 5
A 43-year-old driver presents for a FMCSA-DOT medical certification. History is remarkable for
hypertension for three years, treated with Tenormin (atenolol) and Zestril (lisinopril). He has Type II
Diabetes Mellitus for 10 months controlled with Glucophage (metformin) and hyperlipidemia for two
years controlled with Zocor (simvastatin). He reports seeing his primary care provider every six
months. His last HgA1c was three months ago and was 8.3%. He denies hypo- or hyperglycemic
episodes. His vital signs are height 5’10”, weight 286 pounds, blood pressure 146/96 mmHg, pulse is
86 and regular. Urine specific gravity is 1.030, protein is +30, and glucose and blood are negative. He
reports increasing calf pain when walking in the last month that is relieved with rest. The physical
examination finds decreased ankle pulses. He was evaluated in the emergency room one month ago
for left arm pain.
Questions
19)
Do you need to collect more information before making a decision? (Please select one)
A. Yes
B. No (skip to question 21)
20)
If you think more information is beneficial to make a decision, which of the following would you seek?
(Please select all that apply)
A. Diagnostic tests
B. Specialist’s evaluation
C. Medical records
D. Medication lists
21)
Which of the following is the most appropriate medical examiner decision in your opinion? (Please
select one)
A. Meets standards in 49 CFR 391.41; qualifies for 2 year certificate (skips to question 23)
B. Does not meet standards (skips to question 23)
C. Meets standards, but periodic monitoring required (e.g., 3 months, 6 months, 1 year, other)
D. Temporarily disqualified due to condition or medication (skips to question 23)
22)
If you think the driver should be qualified, but for a period less than two years, when would your
qualification decision expire (Please select a number between 1 and 23 in months)?

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FMCSA-Office of Policy and Program Development

Case 6
A 28-year-old male who has never been employed presents for a new FMCSA-DOT medical
certification so he can be gainfully employed. He receives Social Security Disability support. He
checks “no” for nervous or psychiatric disorders on the medical form, but is taking Lithobid (lithium)
and Zyprexa (olanzapine). Further questioning revealed he has had six hospitalizations for “nerves.”
His most recent hospitalization was two months ago “for depression and suicidal thoughts.” He brings
no documentation for continuation of care, claims no follow up since discharge, and plans to
discontinue his medications because he “doesn’t need them any longer.” He presented for the
physical in his pajama bottoms and house shoes. He eventually admits to seeing people present
whom others cannot see.
Questions
23)
Do you need to collect more information before making a decision? (Please select one)
A. Yes
B. No (skip to question 25)
24)
If you think more information is beneficial to make a decision, which of the following would you seek?
(Please select all that apply)
A. Diagnostic tests
B. Specialist’s evaluation
C. Medical records
D. Medication lists
25)
Which of the following is the most appropriate medical examiner decision in your opinion? (Please
select one)
A. Meets standards in 49 CFR 391.41; qualifies for 2 year certificate (skips to question 27)
B. Does not meet standards (skips to question 27)
C. Meets standards, but periodic monitoring required (e.g., 3 months, 6 months, 1 year, other)
D. Temporarily disqualified due to condition or medication (skips to question 27)
26)
If you think the driver should be qualified, but for a period less than two years, when would your
qualification decision expire (Please select a number between 1 and 23 in months)?

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FMCSA-Office of Policy and Program Development

Section 2: Uncertainties Encountered During Medical Examinations
Instructions
Some certification decisions require careful evaluation and judgment. You are encouraged to share
your experiences about these cases as well as provide feedback about the current FMCSA-DOT
medical certification process in this section.
Your responses will remain anonymous. This information is strictly sought to provide insight into
changes that would improve the process.

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27)
Please describe cases that presented situations about which your medical certification decision was
uncertain or could be debated.

28)
How would you improve the current FMCSA-DOT medical certification process?

29)
When needed, which of the following resources do you typically refer to when performing a physical
exam for CMV drivers? (Please select all that apply)
A. Consensus reports from specialty organizations
B. Federal Register notices
C. Hartenbaum: The DOT Medical Exam
D. Professional colleagues
E. Wittels: Concentra Guide
FMCSA
F. Medical Examination Report form
G. Federal Motor Carrier Safety Regulations
H. Internet sites
I. Medical guidelines including Advisory Criteria
J. Telephone support
K. Other __________________

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Section 3: Role of Medical Examiner Delegates
Instructions
Support personnel may perform some tasks associated with the CMV driver physical examination.
This section is intended to collect information about tasks performed by your support staff.

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30)
Please indicate the tasks that are performed by members of your support staff.
Verify
the
driver’s
identity

Take a
medical
history

Measure
vital
signs

Evaluate Evaluate
visual
color
Evaluate
acuity
recognition hearing

Screen
urine
by dip
stick

Conduct
the
physical
exam

Advanced
Practice
Nurse
Licensed
Practical
Nurse
Registered
Nurse
Physician
Assistant
Medical
Assistant
Clerical Staff

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Section 4: Medical Examiner Demographics
Instructions
Please answer the following questions about your background. Select only one response to each item
unless otherwise directed. Your responses will remain anonymous.

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31)
For how many years have you been performing CMV driver physical examinations? (Please select a
response in number of years)

32)
Which of the following best describes your primary job function? (Please select one)
A. Administration
B. Clinical Practice
C. Education
D. Research
E. Other ________________________
33)
How is your practice based? (Please select one)
A. Academia
B. Group Practice
C. Hospital
D. Military
E. Private practice
34)
What is your primary practice structure? (Please select one)
A. Industrial / Occupational Medicine
B. Primary care
C. Urgent care
35)
Have you had advanced specialized training in occupational medicine (e.g., fellowship, board
certification, master’s degree, ABOHN)? (Please select one)
A. Yes
B. No
36)
Have you completed a training course for CMV driver physical examinations? (Please select one)
A. Yes
B. No

37)
In what zip code do you primarily practice? (Please enter your five-digit zip code)

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38)
In your practice, how many hours per week on average are you available to perform FMCSA-DOT
medical examinations? (Please select one from dropdown)
A. 1-10
B. 11-20
C. 21-30
D. 31-40
E. 41-50
F. 51-60
G. 61-70
H. 71-80
I. 81-90
J. 91-100
K. 101+
In the future, FMCSA may require medical examiners to transmit the name of the applicant and a
numerical identifier as determined by FMCSA for each completed medical examination report.
39)
Are your FMCSA-DOT medical examination reports stored electronically? (Please select one)
A. Yes
B. No
40)
In which of the following electronic formats do you have the capacity to transmit any data? (Please
select all that apply)
A. Facsimile
B. E-mail
C. Web-based form
D. Other
41)
Do you complete a medical examination form for each CMV driver physical examination conducted?
(Please select one)
A. Yes
B. No

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42)
What was the year of your birth? (Please enter year only)

43)
What is your gender? (Please select one)
A. Female
B. Male
44)
With which of the following ethnic and racial groups do you most closely identify?
Please select one or more
Hispanic
or Latino

Not
Hispanic or
Latino

American Indian or
Alaska Native

Asian

Black or African
American

Native Hawaiian or
Other Pacific Islander

White

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45)
Are you interested in being contacted about participating in a follow-up observational study?
A. Yes
B. No (skip to closing)
(If yes,) Please enter your email address so that we may contact you with more information:

Please enter your phone number so that we may contact you with more information:

This concludes the survey. Please click the Submit Survey button to submit your responses.
Thank you for your time and participation!

11/9/2007