So, let's go get started on this now, and form completion, this is the good stuff, this is the final, how do you do the stuff you need to do. So, forms are updated periodically, there's a, supposed to be, there's an expiration date on every form that you look at, usually the FMCSA will update them before the expiration date, but not always, you want to make sure that you watch your email, for FMCSA's and RCME's emails, you want to make sure that you're on, ideally, the OCMET discussion board, because that'll really be very helpful, but at the same time, check the website periodically, that should be one of your starting pages. When we do the, I'm just going to stand back here, it's easier for me at this point, driver information, the driver completes this, it's their personal information, as an examiner, you or your staff have to verify this is indeed John Smith, driver's license, some other ID, and you mark that down, they ask if their FMCSA certificate's been denied, or less than two years, I love the, I don't know, whenever it says I don't know, I want to get more information, the no, the yes, I kind of just take it, you know, with a grain of salt, and if it's a yes, and I'm going to give them a two year card, I will ask, well why'd you get it for one year in the past, and then the driver health history, the driver checks out, we've looked at all those questions as we went through the different modules. Driver signs and dates the form, and this is the important statement, the information is accurate and complete, and incorrect or false information or omission may invalidate the certificate, and may result in civil fines. There actually have been a couple of suits against drivers who lied on their exams and then killed a few people. This is the blank form, I kind of walk it a little bit, I love the, I think I killed this, but we use this, you know, shorter certificate, not sure, surgery, not sure, taking any medications, not sure, that exam's going to take me a lot longer to do. What happens if the driver's not honest, you know, all these kinds of good things, the civil penalty may be levied for false statements or concealing a disqualifying condition. Interestingly this goes back to 2014. And this last name, first name, the exam date, this is the date the examination was done, up here is the expiration date, that's the date the examination was started, and that's important because in a minute I'll explain something else. Not sure, not sure, I'm going to ask more information, any other information, any other health condition, not sure, and answer any yes questions, explain a little bit more detail. This is where they sign, I certify the information is accurate and complete right down here, and here it is just kind of re-emphasized because I think that's incredibly important and incredibly valuable. The driver starts lying to you on something minor, there's a good chance he's withholding something major. Examiners must comment down here on the next page on every yes answer, as should the driver. Examiners should ask for and obtain additional information. This is from the handbook, this is not me saying that, and if you have prior exams, compare to prior exams. Recording the history, if the person's under 21 years of age, you may do a physical under this system, even though they can't be driving, in most cases, on interstate highways. The VA has a program for individuals who have been in the military operating big trucks who can be certified. Some states require the interstate certification and will allow individuals as young as 16 to drive in intrastate commerce, but they need to meet federal interstate guidance. So the bottom line is, when somebody comes into the office and says, I need a commercial driver medical exam, just do it. If they don't have a driver's license, just put none. That's one of the options in filling it in. Again, the other is, if the driver has a driver's license outside of the U.S., outside of the District of Columbia, such as by Mexico, you can do the exam, because some employers hire Mexican drivers. They want the exam done, but that does not go into the national registry system. This is where the health history, this is where the medical examiner, all those yes questions needs to be addressed. And this is recording the physical. Here we have, again, the exam date, not the determination date. Pulse, pulse rhythm, regular, yes, no, height, weight, pounds, it does not say BMI. There is nothing that prohibits an examiner from adding in the BMI once you've got the height and weight. Blood pressure, supposed to repeat it if it's above the 140 over 90, and then specific gravity and sugar. They don't tell us exactly what to do with it, but it may represent an abnormality, they want to get more information. Other testing, if indicated, and this is where vision. This is the one area where you don't need to complete everything. If they're wearing glasses and you've done the exam with glasses on, you don't have to tell them to take it out, take the glasses off, and then do a vision with uncorrected. I earlier was getting phone calls of, the driver won't take his contact lenses out. Why are you making him? We need the uncorrected vision. No, you don't. Okay? If you're testing them for corrected vision and they need it, that's fine. If they tell you they weren't corrected, that's fine. What it means is that they have to have their contacts or their glasses in at all times when they're driving. Otherwise, they can be pulled over and pulled out of service. Check if hearing aid right ear, left ear, and either right, left. You can do a whisper test, as Dr. Bernicke talked about. You do your exam. It is not, will this affect, okay, where do we go here? Even if the condition does not disqualify, consider deferring the driver to get more information. Take the necessary steps. Check for abnormalities. It does not say check to see if it interferes with driving. Is it normal? Is it abnormal? All the way through. And then make those comments and then make the decision of, yeah, he has a fractured left pinky finger. It doesn't cause a problem, so it's not going to affect certification. So it's the abnormality you're documenting and then the determination, does it interfere? Making that final determination. This is where things get squirrely. It is either federal or state. It is not both. You should always do federal. If you can, if the driver doesn't meet federal, then you go back and you say, does he meet the state where he is licensed? They're intrastate. If he drives truly intrastate, if he's an intrastate driver working for, let's say, Sherwin-Williams. It's a paid company. Their paints go all over the country. Their drivers are intrastate drivers. Doesn't matter where is the driver. It's where the scope of the commerce, the material being transferred. The medical examiner has the responsibility to make the determination and the motor carrier, the MC is motor carrier, should have no influence on the final decision. Drivers cannot place restrictions at the request of the motor carrier. What are your options? Does not meet standards, meet standards two years, meet standards, periodic train required. You can pick any time you want. You can make it one year, six months, nine months, four weeks, three days, and 24 hours. I wouldn't go that crazy, but you can. Every time you think, hey, he's stable and controlled, I think for at least this long I'm going to go ahead and give him a short certification. The challenge is, short certification means when that expires, that certification is over, start all over again. You give him three months, three months comes along, new certification. Two months comes along and he shows up back again, it doesn't matter, new certification. You can't amend another certification that already has a determination made. Once you make a determination, that's the end of that exam cycle. Anything other than the new exam, determination pending, we're going to get is the one exception to that. If the driver meets standards and other criteria such as hearing aids, corrective lenses, or intricity zone, you then mark that, and then determination pending, we'll spend more time on. Incomplete exam means exam was started and the examiner did something stupid like saying, oh, you're going to need a sleep study and I'm probably going to disqualify you anyway because you're taking, you told me you smoked pot last week. You've just blown that exam. So you really don't want to start talking about final determinations until after you've already made that and completed the entire exam, and then complete the exam and submit the determination. Federal, use this for any examinations performed in accordance, English language proficiency is not your issue. The only thing with English language proficiency is whether or not you can communicate adequately to do the exam. You can use a translator if you need to. You can use a coworker if you need to, as long as you trust that they're giving you accurate information. But it is a not qualified or incomplete exam, I'm able to communicate with driver, not disqualify, driver does not speak English adequately. That's the motor carrier's responsibility. What about determination pending? Determination pending is a situation where a driver comes in, new driver or recertification. He has diabetes. He tells you, my hemoglobin A1C is 5.6, I'm doing great, dot, dot, dot. You trust him. But you don't have that in your hand, and you really don't want to give him a three-month serve because that means he needs another certification all over again whenever he happens to come back with that information. This is where you can use determination pending. If it's a new driver who does not have a current valid medical certificate, you can certify, you can determination pen them for up to 45 days. You can determination pen them for 30 days, should you choose. During those 45 days, if the individual does not have a current valid medical certificate, they can't drive. They don't have the medical certificate. If they have a current valid medical certificate, they're not a new driver. This means if you feel that they're safe to continue to drive for up to 45 days on their old certificate, they can do so. That comes in very handy when you have a current employee who's probably fine, but just forgot to bring his hemoglobin A1C. That's not a disqualifying factor. It's different than vision because vision's disqualifying. It's different than diabetes because he didn't bring that insulin-treated diabetes form. It's different than vision because he didn't bring the vision form, and he doesn't meet the criteria. So this is where it's a subjective examiner of, he's probably fine, but I want verification that his hemoglobin A1C is controlled. What happens if, during that 45 days, their certificate were to expire? Let me go back to that. They can drive, provided they have a current valid medical certificate. So if their old certificate expires in 10 days, they're off the road in 10 days. So that's their motivation to come back sooner. If their motivation expires, or their certificate expires in 45 days, they have 45 days to come back. If their certificate expires in 60 days, they're out of luck because if they don't come back within those 45 days, that old exam is no longer valid. It's marked as incomplete because they never came back, and they've got to start all over again when they finally do come back. So the determination pending is a, I think they're good enough, there's no medical standard that they do not meet, but I want information before I give them a two-year certificate. As current valid certificate, they can keep operating as long as they have, that certificate is valid. If that certificate is not valid, or they don't have one, they're off the road. It's useful when it's a new hire, or if it's a hire for a different company, because you don't necessarily want to pull somebody off the road just because you want more information when they have a current valid certificate, because if you disqualify them, the newest certificate takes precedence. It's also for a new hire, where do you really want to have the person come back and have to start all over again, when all you were really looking for was a hemoglobin A1C, a glucose log, verification from their cardiologist that they haven't had chest pain in the past five years, something along those lines. As mentioned here, you want to do when they come back within those 45 days, you do not issue a medical examiner certificate for the determination pending. This is the only, only, only, only situation where an examination can be updated, as we used to call it, or amended. It is also the only situation where a different examiner can complete the examination. So someone else in the same office who has access to the same information may, but is not required to, amend that examination. So for example, you have an examiner who comes in every other Monday, and the driver comes back in the Tuesday after the whatever, and that other examiner is not going to be back in for another two weeks. Someone else in that office who is comfortable, works with the other, the original examiner, has access to the original exam, the original information, understands why the exam was pending, can do that amendment, should they choose to, and they'd be the one who would then submit the second determination. Because you submit when it's a determination pending, but then you also submit when the determination is made. On the form, you include the reason for the amendment, broad documentation, you initial and make any changes on the MER, you then sign and date the date you made the determination. So there's going to be two different dates, the date at the top, which is the date the exam itself was done, and the date on the determination form, which we'll get to in a minute, of when you made that determination. The only one situation, different examiner, as I mentioned, determination pending. You can also issue a certificate if you think they're safe and wanting, because they don't have a certificate, it expired, they forgot to come in. You can give them a 30-day, 60-day, whatever you want, 90-day certificate to get their information together. If you believe that they're safe, provided they meet medical criteria, vision, hearing, diabetes, insulin, and seizures is a no-no. You can give them a certificate, but whenever they come back in, that certificate cannot be amended, has to be a new exam. The only time they can come back and not need a full new exam is when they're in determination pending. Everything else, even if they come in two days later, you've put an expiration date, it's done. You cannot write a new expiration date on that. Does the, if they come in and someone else is going to finish that, they have to be obviously a certified? They have to also be on the, yes. Anybody who touches signs, performs the exam, has to be certified. And again, if you put them in determination pending, you do not issue a medical certificate. Medical examiner signs and dates, and the medical examiner certification certificate is the date that their certificate expired, I'm sorry, is the date that the certificate NEC expires. State is pretty much the same. The only difference is you have to be aware of what the state variances might be. There is no determination pending option for state determinations. And no determination, and again, any update needs a new exam and a new 5850. The 5850 is the online determination submission form that you have to do with by midnight, the next calendar day from when the exam was performed. And this is the form that you would use. I have a couple of things. Meet standards, two-year certificate, periodic requirement, certified, three months, six months, one year, requires hearing aid, vision, waiver or exemption. Only right now we have seizure or hearing, skill performance evaluation certificate, exempt intra-city zone. This is determination pending. Why? When do they need to come back? Forty-five days or less. If they came back, when was the report amended, and if amended, when the medical examiner signed it, right here. Down here is the information on the medical examiner. You put all your information, and right here, that's the date your certificate expired. Your medical examiner's national registry number certificate expires. Here is where you put when the certificate expires, if amended. And over here you have the card, very much the same thing, just carrying it over, all the registry information and so forth. Here you have the exam date, and where am I looking at the expiration date? Wait, that's the expiration, you know what, that's the expiration date, that's not the date that the certificate expires. In the beginning we were all getting confused over that, and I'm looking at it again now. So this is the date that your certificate expires, so it will match this date when it's amended. It's the date that's signed. Okay, recording additional information, considering use of the medication form, questions on illegal drug use are not for the MA to address in Part 40. that really does go into that. Prior drug use is not necessarily disqualified. You may want to get information from a substance abuse professional to make that determination, but it really is up to the employer to make sure they've been cleared unqualified through a SAP. English language proficiency we talked about, have to be able to communicate. If you're looking at hearing aids, this is one thing FMCSA has said, please it's reinforced. Either they need a hearing aid and meet criteria with the hearing aid in the one ear, or they don't meet it in either ear, hearing aid or not, then they need the exemption. You should never mark hearing aid and hearing exemption. If they meet criteria select federal. If truly not, determine whether they are truly in trust aid. I think we've explained that. Do not use state only as a restriction, because you have to know what that state allows. The state may not allow, may lift 50 pounds only, or has implantable defibrillator. Also, most drivers will not be falling into that pure in trust aid only. Really should be very unusual. Talked about variances for the state. There are none and no determination pending on state certification. Again, recording it, a lot of redundancy here. Certification does not meet two year, or does not meet standards one, meet standards two years, and then shorter certification. Max is 24 months for normal people, 12 months for diabetes, vision, seizure exemption, shorter period if more frequent monitoring is required, up to 24 months for a hearing exemption. Already talked about that twice. Certify up for two years for a hearing exemption. Determination pending, a little bit bigger print. Why? When do they have to come back? Less than 45 days. Did you amend it? Why? Signed it, and signed it. We've already, I think, covered everything else in there. If the driver does not come back within those 45 days, it becomes an incomplete exam. FMCSA will do that automatically on their end. For your record keeping purposes, you can certainly go ahead, mark it as incomplete, and submit it as incomplete into the registry system as well, although you don't necessarily have to. It's just as helpful for your record keeping. They can come back in on day 47, 48, it's a new exam, they've got to start all over again. Incomplete, why did they walk out? Because I was stupid and told them I'm going to disqualify them. You really don't want to do that. You sign it, medical examiner signature, type, address, phone number, all that kind of good stuff, and then the expiration date of the medical examiner's certificate, the 5876. Incomplete exam, driver can stop whenever they want to. Our goal is to not want them to stop. FMCSA will theoretically review when there's two conflicting submissions. Again, this is just my humble opinion, don't discuss determination or duration until the examination is totally complete. State, I think we've kind of discussed that, don't complete both, it's one or the other. If you choose state, it's not a restriction, it means the driver does not meet interstate criteria, but does meet the intrastate requirement where he is licensed, and you have to know that. If you don't know that, just disqualify them and let them call the state themselves. Recording, wait until exam is complete. If you have any questions because the driver makes you feel threatened, this is a phone number you can reach. Driver certainly can have that second opinion, but must provide the same information to the second examiner. This is the medical examiner's certificate, it's pretty much filling in the same thing all over again that you put on the form, and there are copies of the forms in your syllabus. What do I do after? This is, submit determination online, close of business following calendar day, provide a copy of the certificate to the driver until 2025. If they have a CDL after 2025 June, the information will be in their commercial driver licensing information system. The state system will have it in there that they have the certificate. Now it gets confusing because those individuals that do not have a commercial driver's license, remember that 10,000 to 26,000 pound I keep talking about, they will not be in the state driver licensing system. Those individuals who are truly in trust state only do not have to be submitted to the national registry system, this 5850 submission, so you need to give them a medical certificate. Individuals who are foreigners, who are foreign drivers, Mexico, Canada or other, are not in the system. You still have to give them a medical certificate. So it gets a little complicated and it's getting close, but unfortunately not too close. Those that are not commercial driver's license holders or permit applicants or permit holders are the ones that would still need to get the certificate. This is what the 5850 looks like and they just, you know, fill in examinees, examiner's license, driver's information, state and country, and then you keep going down, date of the examination, date the MEC was signed, and the certificate. And then any of the other, waiver exemption, qualified, this operation of 391-64 no longer exists. That was those who were in the former vision or diabetes waiver program. I have to update that one slide, I can see. Medical points for determination, driver and employer are responsible for making certain that exemption or variance was obtained. It is not the examiner's responsibility and I just like to repeat this because the drivers are responsible for giving you accurate and complete information. If not, invalid exam, a lot of examiners will say, hey, if you lied to me once, I can't trust you not to lie to me again. And then of course it is the potential civil charges. The exam date itself does not belong, it does not appear on the certificate, so that may get a little bit confusing. It is the date the determination is made is what's on the certificate. So if they are certified the day they show up, that's the day that's on the medical certificate. If they are certified 45 days later because it was a termination pending, that's the date on the medical examiner's certificate. The certificate expires, well, at midnight that day. So it's not like you get a grace period of until 6 o'clock the next morning. When it expires on June 15th, it's done, June 15th local time, so it doesn't mean you kind of go running and try to find a time zone that's a little bit later to give you some more time if you can find it. And again, I don't know why I was saying this has been a long day. It's not the medical examiner's NRCMD certification, it's the medical examiner's certificate when that MEC, that 5876 expires. What's permissible, you can't change the form. The form is the form. Unlike the old one that was substantially in accordance with, the current medical examiner's form has to look the same thing. You can add a bar code as long as it fits. You can resize as long as it's legible. You can make instructions available separate, because right now the form has about eight pages with the instructions. I'm not going to tell my story, but you can't keep them separate. You can reduce the size of the MEC so it fits in a wallet. As long as it's legible, you can use additional pages for information, because there's not enough pages and spaces to write all the information that is needed in a lot of these drivers. You may not alter, add, or eliminate anything, and you cannot add questions or a company logo. That being said, companies certainly can have an ancillary questionnaire that they may want completed at the time of the examination. Frequently asked questions. What happens if the medical examiner changes employment? They advise, they reach out to FMC and say, guess what, I'm not working here, I'm now working there, here's my new email address. That will prevent you from getting pulled off the national registry. They also need to make certain that you have a current license in the state in which you are practicing. You must be licensed in every state where you're doing exams. You do not need to be licensed in every state where the drivers are operating. A driver may come to you in Illinois, but be licensed in California, which is why it's so important that you don't start doing the intrastate only, state only, because you may not know what California's doing. Licensed in the state where you're doing the exam, not licensed in the state where the examiner has their CDL. Is the certification limited to current employment or job duties? Nope, we've said that. That medical certificate is good for any company willing to accept it. Totally different job requirements may exist, which is why you're not just looking at what are they doing now. May a medical employer maintain the records at a centralized record or electronic health record? And the answer is yes, as long as these forms are maintained, whether it's electronic or paper, it is okay. Period of time, at least three years. Now in this case, check what your state medical records retention requirements are, because it is generally, in many states, seven years. So you want to make sure it's consistent with at least three and whatever your state's records requirements are. We talked about the variances, and that was the end of filling in the forms. So hopefully we have given you, and I hope we haven't broken this. Remove this gently. It looks fine now. So questions, because we've covered pretty much everything we're going to. Hopefully between the forms, we did not want to scare you off by saying there's really no absolute requirement, because there really aren't any absolute requirements. It really has to be, at this point, it's a common sense exam. It's a, what would I ask a patient who comes into my office with this condition? How would I decide if they're good enough to go back to work? What kind of work do they do? Is it a safety sensitive job? Yes, no. That's pretty much what this needs to come down to. Is the person's medication likely to interfere with them cognitively? Is it likely to cause side effects that are unacceptable? Syncope? You know, it's really looking at and understanding what the medical conditions, as I said in the beginning. Diagnosis, prognosis, treatment, complications, long-term. You know, is that person stable and controlled? So I work in a large health network with access to everything, right? So I have all of these medical records. Okay. I know where you're going. Let me ask my question. So I have no treating relationship because I am a medical examiner. Let me, because I know where you're going. I'm going to answer your question, because I know what your question is. It comes up every time. And I've got to say it so the microphone can get it. The question is, I work in a health care system that has one of those large medical record systems such as Epic. I have easy access to everybody's complete medical records. Am I required to look? Am I permitted to look? Am I prohibited from looking? The answer is, it depends. First of all, the problem is you cannot look unless you have permission generally. So you want to have that driver's sign of release. Secondly, should you look is the second question. And the likelihood is if you have access to it, you probably should look because what happens if he has a seizure disorder? And this was sitting and staring right in front of you because most of these systems are not well firewalled off. And for them to firewall off, it has to be separate systems because they're going to have all the diagnoses are going to be cumulative. All the medications are going to be cumulative. All the office visit, next visit is going to be cumulative. So are you required to look? No, but it's really hard to not peek. I don't know, when you see something that you know you shouldn't look at, you've got to keep looking at it. And that's the same way. Are you permitted to look at it? Not unless you have permission to look at it. And your next step is, I'm not giving you permission to look at my other medical records. I'm sorry, I can't do this exam. This is the health care system we're in. This is what we have access to. If I don't at least look at it, I'm probably not doing a complete evaluation. And one thing along those lines, the prescription drug databases that states have, you should be aware of the laws that surround those exams to be looking at them. I would venture to say that most states do not allow you to look at those in the context of doing a physical exam for purposes of employment. There has to be a doctor-patient relationship and an intent to treat. So my state has defined that you cannot look at those because a physical exam for employment purposes is not a doctor-patient relationship and there's no intent for you to treat. Therefore, I am not allowed to look at the prescription drug database to verify whether or not the norco they say they're taking once a month, that they're actually taking it. You can get that information under ways, but that's under a precaution. And as an MRO, you cannot do it either. So again, how do you get it? I call the treating provider and say, have you checked the PDMP lately, or whatever it's called in your state? And they say, oh, can you double check? He's telling us he's taking these two medications. Can you verify it? Other questions? Did I get determination pending? Good enough? Yes? If they come and see us on October 1st and they come back October 20th, is that one year from October 1st? It depends on what you want to do. There's no precise amount of time. You cannot certify them for more than two years in general. You cannot certify them for more than one year under certain circumstances. So for example, if they have... It doesn't matter whether we use October 1 or not. TPAs will say, oh, it has to be the date signed. No, it doesn't have to be the date signed because you can do it for nine months if you want to. It's probably easier to give them a year, but it doesn't mean you have to. Anybody else? Yes? Would you say sort of a major difference between now and when we did it before is although they've taken away a lot of the guidelines in and out, it seems like there were multiple references to the MCSA forms. Are you really recommending that we really try and incorporate those? Those forms have been required all along. That's nothing new because you had the 58, 75, 76, and 50 were from the very beginning of the National Registry. There's two new forms. The other forms which are for the vision alternative diabetes are required forms. That's gone through rulemaking. You have no choice. The non-insulin treated diabetes form and the optional medication are both optional forms. I mean, they're there to help examiners. You don't have to do them, but they were presented or provided for you because they're useful. And as far as things have changed, the big difference truthfully is now they've actually taken away that stuff that they said you can use as your starting point because examiners were using it as their end point. And now they're saying use your common sense, which is kind of what they were saying all along, but they weren't directing you to say that very well. I was going to ask, what's the actual exam like? Is it 100 questions? Is it like a two hour, three hour, four hour? I think it's a two to three hour. I think it's like a two hour test and I think there's like 100 some questions. I don't remember. It's pretty boom, boom, boom questions. You may want to have to calculate the hearing. You know, that's probably the most work you have to really think about. I'm sorry about my daughter. So, the question I had was, I know that in the NAFTA thing you can have, you know, recognize a Canadian, you know, as a parent and physical thing, and they don't have to just speak English, but if you have to do a verification for medical conditions and treat it from that country. I've never had to do that, but you could have to do that. Again, if you can communicate adequately, get the information that you need adequately, it's an incomplete exam and have them sent to a place that can do it. Some places use translators, some places have multilingual assistants in their office, so it really depends on the languages. The Canadians, yeah, usually you can figure something out. Mexican, usually you can find someone who speaks Spanish. Again, you may have somebody in your staff or somebody else, there's also translation services that could always translate. Worst case scenario, scan it in and have Google Translate do it for you. All right, well, we thank you. We hope we gave you enough information that did not confuse you. I think there's probably less confusable information now than there had been because there's less definitive information. But, you know, in truth, I think this is probably about where it should be in that it is, you know, here's some information on the condition, keep in mind we're looking about safety, keep in mind we're worried about stability and control, keep in mind we're thinking about etiology and risk of recurrence, keep in mind that we're thinking about whether or not there's side effects from the condition. And at that point, it's are you comfortable, can you sleep at night certifying that driver or not? If the answer is no, don't do it. If the answer is yeah, I'd be comfortable having them drive next to my family, then certify them. It's no different than asking the treating provider, would you be comfortable? Just like my picture I put up, would I feel comfortable having them drive next to my kids, not kids anymore, and hopefully one day my grandkids? That's the metric I'm going to use. So, thank you.

commercial driver medical exams

form completion

driver information verification

health history accuracy

federal standards

intrastate vs interstate regulations

medical examiner role