CDME Module 2: Vision, Hearing, Diabetes Mellitus-2-5: DRAFT

2-5: DRAFT_NON-ITDM Form for MRB Review

Pdf Summary

This document is a Non-Insulin-Treated Diabetes Mellitus Assessment Form from the U.S. Department of Transportation's Federal Motor Carrier Safety Administration. It is used to evaluate an individual's physical qualification to operate a commercial motor vehicle (CMV) in interstate commerce. The form includes sections for driver information, responsibilities and demands of commercial driving, and a diabetes assessment.<br /><br />The responsibilities and demands of commercial drivers vary depending on the type of driving they do, including schedules, physical demands, and lifestyle factors. These factors can impact a driver's ability to perform their duties safely, and include irregular sleep patterns, long hours, tight schedules, adverse road conditions, and environmental factors. The form also emphasizes the need for agility, bending and stooping ability, and other physical skills required for tasks such as inspecting vehicles and loading/unloading cargo.<br /><br />The form then moves on to the assessment of the individual's non-insulin-treated diabetes mellitus. It asks for information on the date of diagnosis, diabetes-related medications and treatment history, blood glucose self-monitoring records, diabetes management and control, hemoglobin A1C measurements, and any diabetic complications or target organ damage. The form also includes a section for information on diabetic retinopathy and the date of the individual's last eye exam.<br /><br />The form concludes with a section for the treating healthcare provider to provide their assessment of the individual's diabetes management and control, as well as any concerns that may adversely affect their ability to safely operate a CMV.<br /><br />Overall, this document serves as an assessment tool to determine whether an individual with non-insulin-treated diabetes mellitus meets the physical qualification standards to operate a commercial motor vehicle in interstate commerce.

Keywords

Non-Insulin-Treated Diabetes Mellitus

Assessment Form

U.S. Department of Transportation

Federal Motor Carrier Safety Administration

Commercial Motor Vehicle

Interstate Commerce

Driver Information

Responsibilities and Demands of Commercial Driving

Diabetes Assessment

Physical Qualification