CDME Module 8: Drug Abuse & Alcoholism-Optional Medication Form 5895

Optional Medication Form 5895

Pdf Summary

This document is a form for certified medical examiners to evaluate whether a patient/driver meets the medical standards of the Federal Motor Carrier Safety Administration (FMCSA) to operate a commercial motor vehicle (CMV) in interstate commerce. It includes information about the regulations for physical qualifications for drivers, specifically regarding the use of medication. The form asks the medical examiner to list all medications prescribed to the driver, any other prescribed medications by another healthcare provider, and the medical conditions being treated with these medications. The medical examiner is then asked to provide their opinion on whether the medication has any side effects that would affect the driver's ability to operate a CMV, and whether the medical conditions being treated would have any adverse effects on their ability to safely operate a CMV. The form also includes a section for the prescribing healthcare provider to sign and provide their contact information. On the second page, there is a section about the driver's role and the various responsibilities and demands they may face, including irregular sleep patterns, long hours, and environmental conditions. The form concludes with a section for the certified medical examiner to sign and provide their contact information. This document contains sensitive information and should be handled and secured appropriately to prevent inadvertent disclosure.

Keywords

certified medical examiners

medical standards

FMCSA

commercial motor vehicle

physical qualifications

medication regulations

prescribed medications

medical conditions

side effects

driver's role