40-1 504 R05/05                  MEDICALEXAMINERCERTIFICATE
I DriverName                                                                                             I
i*rr-",tr"r ' *^                                                    (
F e d e r a lM o t o r C a r r i e rS a f e t y R e g u l a t i o n s 4 9 C F R 3 9 1 ' 4 1 - 3 9 1 . 4 9 )
and with the knowledge of the driving duties. I find this person is
q u a l i f i e da n d , i f a p p l i c a b l eo n l y w h e n :
D Wearingcorrectivelenses                               J Wearing a hearingaid
D Accompaniedby a                                                              waiver/exemotion
O Driving within an exempt intracity zone
O O u a l i f i e d y o p e r a t i o n f 4 9 C F R3 9 1 . 6 4
                  b                   o
I Accompaniedby a Skill Performance                     EvaluationCertificate{SPE)
The informationI providedregardingthis physicalexaminationis true and
complete. A complete examinationform with any attachm-ent        embodies
my fjndings compietelyand correctly,and is on file in my office.

 Medical Examiner Name (pnnt)

 Mediml Emminer Signature                                                I Date

 O MD        O DO Cl Chiropractor
          O Physician       O AdvancedPracticeNurse
 Medrcal Ltcense or uenlllcate          NumDel I )rare         I rnone

                                                   L           l(          )
 Dnts            Nuhtter                                                                       state

 Driver signature                                             | | hls Medlcal uenlllcare      tsxplres
ao llot   D2lo6
                                                                                                                                                            Commorcid Orivcr Fitnar Dotarminrtion

 O tLw Cstltbnlon                  O R.-c.nttcdn                 O fofow Uo                                                                   c'a      OB   Oc    OD     Ctoitv:
HEALIH        HETORY         otiv.t cotF|.t    t thh..cdotr,   hrr il.dbd.rcni.rr         L    to.Ircu..   whh drts.

 oo          A,ryCiaardLlsyh|mlffit                                                 oo       f{rog dox,    Fgtltm,      -frrnr.   ctr.ulc   b.otdtrb        cto   f*dr|e.  drrho
 oo          t{aadlr-n hletr, Oao,rtc s Jtw                                         oo       atrytt'r,W.                                                    oo,      tatr     h bndlng       w'{a    j||.g,
 oo          F.arffi, filgry                                                        oo       tjrtm                                                                drtnm Ja.paffi,      lord whg
                 O llnloroo:                                                        cto      Olfrrtvr t!tl@                                                 ocl   Stro*a d ,a.d!d
 oo          Et[ dFfiart t lrlldla tltloo l.rc.Oi agFdn hd[l                        oo       Ol-t a r rbrrad lbod rrer 6.t!roar.t '':                       oo    ffr.i!9   s rnptu        hnd, @, fuL    at,    f''NJ,    It
 oo          Er dao(b[, |or ot harnrg d b.lm                                                     O Dbr                                                      oo    6tid    i*ry     qdirr
 oo          Hfrt d-t      d hxt dtrt; odr criloyaE f, @idrioi                                   Ofr                                                        oo    Ctwfc bw brct prlr

                 Cl rtcoroqr:                                                                    Ct hartrl                                                  oo    Aatd-,     lr.$!rr     rkgftot m
             HGt rr.fry (vafrr ,r'fma.tly'|a,      a{,f4l,'rf , rffiJ*JI            oo       ilru      t tttrrltitb dLqd..r, ..9,, !@ d?txdcn               oo    xrEdc      d hdtt trnttg       dnrt s
 oo          ,reh uood Frnn       Cl *cardqr                                                     Ct lbccdqy
 oo          litus|fdlrg                                                            otr      La ot, r drrrd GFadoEffi
 oo          9br0t6r of !'ilh



Mtdad      ErDitaa   ctmmnta     on lLdth     H-toty (Tha tttadicd sratrir.t muat tayiaw rnd dbcca wih divcr s.v 'va.'mwlrr   arrd poiartirl tlazrrdr ot ,r€dbrtin
                                                      inclrdlE orrar-tha.caantat tffin,      whfla ddvhg. Thb di$uBion muat bGdocmnt       d bclow.,

                                                                                                                                                                                                                 P|!|. t o{8
TESTING                1tlrrfat Erry*u mrt mpbr.                        th. mdntng Er{or.l
         eye. Tho us ot conective lcnss shqld bc rcrcd on rhe M€dicsl Errmine, CGrtificatc.
Instrclions: When other thtn tho Smlbn chan E u$d, give test r€uhs in Srisn-coopanbb        vdrs. In .ecording dislare vision, us 20 fet s normal. Repqi visim acuity as a ratio with 20
conlact   leoses, or intsds          to do e   while    drivi.rg,     sfficiont     cvide@       ot good toldrrce           Jd   ad.ptatim       to th€ir use must b. obvious,          Mmcqlrr      driveE   rre not oullitied.
   Acuity        Uncorgctsd            Cdr6ted                 Hortmtd        FicH Ol Via6                  El Ycs      6 llo     Apfilbant  cen teognir€  .rld           diEringuash      6mong t.aftic   control   signals   and davices   showing     standard
Riqht Eve        20.1                 20r                     lioht   Es                                                          rsd, gre€n alrd amber cdofs?
lsft Ew          20.t                 201                     -dt EY€                                       Applimt      meets   visal    *$ty     rcquistmt          only when    wearing:     O Conetive      Lmss
Both EG          2at                  20t                                                                   O Ye        d llo     Moreutil         Vision?

Comgl€te ncrt line only if visbn tostihg is dons by rn ophth.lmologist or optomotrist.

Examtnilpn       u4e       Jpnlnlmobgrs          of up[omtnat           Nmg                                                                              !rcg@        NumBt        Stato       SrEmturc
                               O ClEk     if h.lting  !i, us.d fq t6ts.    O Chock il h€rirg   ri' roquired to ret  st'ndard.
lmmrctims: To mft                  tudimtic      t6t G$hs ftoh lso to ANsl, -tadB lm                           lso lq 5oo tlz, -1o d8 for l,ooo Hz, $.5 da tq Hz. To awagE, add t?E re.dings tor 3 ksqwies                                       tcstcd afd
divide W 3.
El R@.d      dkt.rca      from ifflividsl      at which       lo@d      whiscd         rcbo     6n   t!fi     bG hord.                   tl lt lrdiorctd       is us€d, .o@rd loss in d€cib€ls (acc. to ANSI 224-5-t9511.
                                                                                                                                                                  Riahl Far                                           Left Esr
                       fe€tt   I                       leet                                                                              5(J(JHz             I l(XX) Hz                                    5W HZ               I tqx'   HU     I Z(XX) Hz


BLOOD PnE$lt{rRErFlrLSC RATE (llmglcd                          nrdng:       orurr Dc reord.d.l              Madial examimr shoutd take ar least rwo rerdings to confirm Bp.

                         I tYstdrc                | ut&tottc
 l|oodhcm                I                        I                                         R.rdhg                    Crt gort                        Erpfrlton D.t!                                                    Rccqdftcrrim

Ddvd qualified if < r4O/9O.                                                          rtr(,-159/90-99                  Staoe 1                                I l€at                                               I Yeafil s140/90
                                                                                                                                                                                                  Om-time cenificste lw 3 months, if 141-159/91-99
 Puba Rao:         O RcAular           O krcgdar                                   r60-179/r@-10!l           2             Om-tic       cenifbile      lor 3 moorhs                         I year from date of exam il < I4O,/9O
itsord    Pul*   F€te
                                                                                       > 18()/t 10                    Stsg|o 3                                                                                       6 mqnths if < 14O/9O
                                                                                                                                    6 mr|th3       from dil6 ot cmm           il < 14O/9O

LABOnATORY AtlD OTHER TEST FlllDtttcs                           ttmrrb.t          radtngt     mrt    b. reord.d.l

           lr Eq(rH. Prctin, blood or sugar in the urim my bg 8n indicrtion tor funhs
to rule oul rny uodorlying mcdhrl problcm

                                                                                                                                                                                                                                                Page 2 ot I
                                                                                                    ]rive,   Nam
  PHisrcAl ExaMtitATtol{                                                                                                                                                                            uovd      Lrcensg Numbet
                                                ft           m                           lbs
  Th' pfesnco      ol a certdin @nditifi     m.y not mc$ily            disq@litY . d.iv€., panbulady     il th. condirkm is emtrolbd        .dcqu.tely.    b nor liiely to wo.aen o, is ,eadily arnable    ,o:;;;;;
  as soon as possiblc; P.niculsty       il th€ cs{tition,    il rEglected. c@ld GDuh in mle       *rkrus     illm$  thrt mirht aft6t     drivirg.
           'ys'                                                  'm"
  chock          il lhsro ae arry ab<rmalitbc.          ch6k           il the body systam E ffimd.       Discs           'yes'
                                                                                                                   any           mwe6      in detril in ttE spile     b3tow, and itlicare  whethef it would afst    the drivsr.s
  'bility to opente r comrcial       mtor whicb sately. Entor spplbablo itsm mbsr                 befor eih commt.             tf o.gsic  disas      is present, rte    thit rt has been compensated for. see -tnstructions To
  The-Medbd     Examimr' fd goit ance.

           Eody System                                            Chck Fu:                                                         Body System       I                                            Chect Fo,t
               I Ap9rarre                            Mlrtrd wight,      t|w,    qFr                ot rtcohotis,              7. Abdmn.r|d
                                et Yes' Cl No                                                                                                 Vi$era                             Fnlarged livq, cnbrgld splen, masss, bruits. hamir.
                                                     Drobbm drintim- or dtuo .bF-                                                                            f Yes' Cl No
                                                                                                                                                                          signifiernt lbdmind           wall mu*le    wssk|rEc
   2. Eyos                                           PupilL.y aqu.lity,      ffitin          ro f,gh. lccmmodrtio,            8. V.$ular
                                D Y6'        O llo                                                                                           systcm                              Abmrmd pd3e and mplitude,         carotid or anerial
                                                     @dar rctility,       cda        mu$lG &nbatrfte,          enr&uLat                                      OY6*ONo
                                                                                                                                                                                 ,tuits, vailce  veins.
                                                     mow|lut.       nystagmc,           .xophthahos.         A3t rbout
                                                     rslirrcpathy,   crtrract3,        .ph.tia,    glau@ma, |wdar
                                                     d€Offiatim       rnd rols to cidin                 if aomdi*e
   3. Elrs                                           Scfring of tympflic           ffirtoil,         cctcion     of axtsaE
                                C tY $ ' O     No                                                                             9. Gfiito-urin!ry   system                        Hernias,
                                                     :{al,    rrtorded      ardtm!-                                                                          O Yca'   O No
   4. Mouth .nd Thral                       rrcrns({abb doformitiar lik lv to in rfa" with
                                O Ycc* O No                                                                                  I O. Extremitbs - Litrrb                            Loss or impakmst     of lsg, t@t, to€, arD, hard, fings,
                                            Yorthing or swallowing.                                                               ,mpsired- Driret may       O   Cl t'lo
                                                                                                                                                                                 Pcrceptible limp, delo.mities, at ophy. wcrkmss,
                                                                                                                                  b€ 3ubict to SPE                              p.6lysis,   clubbing, edema. hypotonia. lmufficient
                                                                                                                                  c€rtilicrte ii ottErwis                       grasp snd p.ehansion in upper limb lo mainlain
                                                                                                                                  qulltfied.                                    steering wheel grip. Insufficbnt moulity and strcngth
                                                                                                                                                                                n lowet limb to oBata      Bdrls    ilffirlv
  5. l-lsln                                          \tmqF,       cxtru smds,        eda.gcd     hoan,    peomlsr,
                                f Ycs'O ib                                                                                   ll.Spinc,othot                                      'Bvious €urgsy. d€lomities,      limitation of mtion,
                                                     mldlntrblc     dsf ibfil.tor-                                               mu*ukrskal                  O Y6s' O No
  5. Lungs eod ch€si, rcl                   Abm|ml chcst waf .xprGam, ab[remd rerti.rtory
                                D Yes' D No                                                     12. ileurologicrl                                                               lmpaired equilib.ium, coordinrrbn         or spsh      gattsan;
     ircluding brsan                        rtta. lb(€ma{ breath snds imluding hih€ezes d                                                                    O Yes' O No        par€sthesia, €ymrctric      deet tsdm          re{lgxes.
     examinatiotr.                          alvobr rabs, imFEk d .6phato.y fumtim, dylpEr,
                                                                                                                                                                                sensory or poshional abrnrmaftie,            abnormal lEtellar
                                            cyansir. Abnomd firdings oo physic.l exlm rEy                                                                                                                           *
                                                                                                                                                                                and Babinski's retl€xes, ataxia.
                                            rcquirr tunh€r testing ffih a p(dmmary tgsts and/ol
                                            x-rEy ot chest-

 O Meets st .dards in 49 CFR391.4i; qu.tilies lq 2,yea, ccnificrtc.
                                                                                                                             Cl Wearing corrociie bn$s
 Cl Dc mt md standlrds
                                                                                                                             0 Wearing hearirg aid
 O M*ts nandard3, but p€rbdh ev.lirsrion r6ouied.
                                                                                                                             O Accompanied by a                                          waser/exemDtaon
     Due lo                                     ' d'ivs qucified onlv fot:                                                   O Skill Perfomance Evatuation(SpE,Ce(ificate
         o 3 months ct .r yerr                                                                                               O Driving within an exempt invacitv zone-
         Cl 6mrhs      Oothd:                                                                                                O Oualilicd by operatim ot 49 CFR 391 .64
 O Tempqmrilydicqualifieddue ro lcondition d rudicationl:
     RetGn to trEdbat exmim.,s oftbe lo, tolorw up on:
 rcdrcll    Exrmaner Ngms                                                              rge                                                        wntrcate     Numbea      Mcdical Eramine.       Signature

                                                                                                                     u[y                                          Stde
l{ driwr |wrs

                                                                49 CFR 391.41 PtrysicalOualifications for Drivers
The Ddver's Role
Reryonsibilitie, rcrk *hcdules. physical and mtioml      dmds,        ud lifctytG alrug @mtmial          drivers vary by thc typ€ of driving that they do. sorc of thc min typa of drivers include thc
following: tum mund or shori ctay (drivers rctum to iheir hom bc* cach wming);img               rclay (drivm drivi 8-to houm ua tben have a 8-hour off-duty p€riod), sraiSht thmugh haul
                                                                                                              rFhour rcst periods'
country irim);     sd tam drivm (&vm she thr driving by rltmating rheir 4-hour driving periods and
                                                                                                                                                                                          beginning a
The following factm may bc involvcd in a drivq's pcrforw           of duti6; lbrupt shedule chmga md rctating work sh€dulcs, which my mult in ireguta sktp Paltcms and a drivtr
                                                             *lrich my r*        delalr nrd lerdio huniedly loading or unioading cargo to corq€nste for thc lost timc; md envirnmtal        @nditims
mting prttms, advffi road, wcrthd rnd trafc onditim,
such-u cxcxive vibration, noiq and stqns       in tcrrycnnre. Tmspo*ing passmgm or handms mtrials may add to the demnds m the sfficial                         drivs'

Thuc my bc dutia in ldditid to t6g driving rask br which a driq is rcspomiblc urd ncds to bc fit. Som of th* rcponsibilitic               r: mpling and unoupling traile(s) fom.the trtor, loading
 ability to ctimb ladds on the trete mdd tail€r(s).
                                              srrns to tmrts      a srrptirc    qrplcx &iving situtiuL thc judgrrEnt skius to mke quick dcisiong whm nws*Dt'              md thc mmipulativc skills to
 In additiq, e ddvq mst hsE thc trcpe8l
 mtrol m|)6iu         staingwtcl,   shiftgmEingalmual         irusr4isim, and tm@vqevehiclc           in mwded m.

391.41 Phy3lal                    F6 Drivcr
                                                                             (?) Hc m etablishcd medicel hisrqy q cliniel diagrcsis                   (ii) Exception, A driu my * T"h u $bstance or drug' if
(a) A pason shall rct drirc e mial             mdtr vdticlc ml6s                                                                                  |
                                                                        of rhcrmtic, utluitic, orthqcdic, mwlu,               **l-,               I   ahe sbstance c drug is pmibed          by a licasd    medi€l
he is physially qulifi€d to do $ m4 accpt s prcvidcd in
                                                                        or wlr          dis*    which intcfem wirh his ability to mtol            I   prrctitimd who: (A) Is familiu with thc drivs's redical
$391.67, hs m his pets           thc origiml, tr t photogr.phic
                                                                        rd q.f8tc 8 coffiid             mtor v€hiclc efcly,                           history ild assigned dutie; and (B) Hx edvised the driva that
crryy, of a mrdiel qemim          c€ttificd. that hc is physielly                                                                                 I
qurlif€d io driw a mmid            tntor vddclc.                             1fj Has no cstsblishcd mcdicil histwy c clinical diagnsis            I   the prcrcribcd sbstancc or drug will not advemly affcct the
                                                                        of cpilcpcy u any otha mdition which is likcly to ou* bs                      drivcr's ability to sfcly oPcrate a camffiial  mtor vehiclcl
@) A pasm is     physically qudifi€d lo driw a trFtor vdlicl,e if                                                                                 I
                                                                        of con*iourc          or any toss of .bility to mtol     a @r|rmial       I   md:
    (l) Hc m lG ofa fooq a lcg, e bard, or il.rr\              or has   mtor rchicle.                                                             |       (13) Hs no clinical diagrmsisof Jcololim.
banr groted a Shll Pdfornmc           Ewlu|tim (SPE) Cq.tifi€tc              (9) Hc no mtal, nwou, orguic, or functimsl dise                 or
(formaly Limb WaiwPrcgm)p|Nml                    to $391.49.            psychiatric disrdr       likely to interfse wilh his ability to drivc a
    (2) Hs m inpaimt           of (i) A hud u fingc wttich              omwial           mirywhicle.
intcrfaes with pr*mion       of pow gnsping; or (ii) An m,                   (10) Has distant visul dity of at lcast 20140 (Smllo) in
                               with the ability to pcrfom ml            *h cye without mtiw                lms      q viul   aoity xpardely
fmt, tr lcg which intqfm
tasks asgciarcd   with opcrating e mial             motor vcticlc; c    orEt        to 2Ol4{) (Srellm) or bcttcr with mtirc             lm,
my otlrcr significmt limb defcg or limitation *hich interferes          distant binocular mity of rt lcast 20/lO (Snellm) in both eyes
with tbc ebility to pcrfom nornd tasks a$ociatcd with                   with or wilhout mn*iive          kns, ficld of vision of 8t lcast 70
 openting a mfiffiial      mtor vchicle; or bas bcn gmtcd a             dcgrccs in the horimtal midim              in mh cp, and thc ability
 SPE Cenifiote plrMt       to $391.49.                                  to lugnia         lhe colon of taffic sigmls md d*im           showing
    (3) Hr no atablished mcdiel history u cliniel diagmsis              trdad        rcd, gltm, and mbcr.
 of diabdcs mlliors omtly       requiring imlin for mtol.                     (l l) Filst pcrwivs a forccd whispcrcd voice in the btltq
    (4) Hss m mt             clinical diagmis         of rry*ardial     d not ls than 5 k witb or without the us of a htring aid,
 infarction, mgim p€ctoris, mnuy          inzufficiocy, thsnbosis,       or, if tcstcd by w of m rudiomtric &via, dG not haw an
 c my odrc erdiowlu             disasc of    a vericty knom to bc        amge hcring lm in &c beua ar grcatcr thc 40 decibels at
 morqanicd      by syncopc, dppnca" collap*, or mgstiw                   500 Hz, l,0m Hz ud 2,000 Hz with G without a haing aid
 cardirc failm.                                                          f,'h6 the audiorctric          dcvice is calibntcd to Amqicu
     (5) Has no cstablishcd rcdical history or clinical diagncis         N.tiffil Strnd{d (fmrty           ASA StandatdrZ24.S-1951.
 of a respiratory dysfunctkn likcly to interfffi with his ab'ility            (12) (i) Dos mt ur a controlled substance        idcntified in 2l
                                      motor vchiclc sfely.               qFR l30t.l I Schedule I, m amphetamine,8 namtic, or aly
 to mtrol md driyc r omid
                                                                         otha habit-foming

                                                                                                                                                                                                      Page 4 of 8
                                                                              lnstructions To The Medical Examiner
Gcrenl Inforauafur                                                                                    Fedcr.l ilotot      Carricr Sa{atv Regtdations - AdvisotY Cdtqia
Th€ purpos of this examination is to dctemine a driver's
                           to opeBte a mmmial              mtor vehicle    l,os of Linb                                                           Dirbct6
physial qulifiotion
(Ctttv) in intcFtrte 6mmrce amrding thc rEquirctrmts in                    l39l.4r(bxl)                                                           $39r.4r(bx3)
                                                                                                                                motor             A permn is physietly qulificd to drive a @rrercial   rctor
49 CFR 391.4149. Thcforc, thc mcdisl cpmind must be                        A p€mn is physicatly qualified to driv€ a coffiial
                                                                           vchicle if tbrt pcmn:                                                  vehiclc if that pcson:
knowlcdgable of rhe rEquiremors ad guilelina dwelopcd
                                                           in mking thc    Ht w los ol a ful leg, hmd u an am. or     hu beu grantd               Hu ao atablished mediill hittory or clinical diagnosis of
by the FMCSA to sist thc mediql samim
qulifimtion      dettrminrtim. Thc modi(d aamim duld be                    a fiill Pufomnce      Ewlneion (SPE) Cenilicate pununt to              diabct* mellih.s cunently requinng inmlin lor cqvol.
famitiu with thc &iu's         rcspsibilitie    md mrt avimrnat            &ction J91.49.                                                             Diabctcs trellitus is a discase which, on masiof,, can result
                                                                                                          _                                                                      q disorimtation in tim md sprce'
ild is rcf€rrcd to dtc sctim oo $E fonL Thc Dris's Role.                                                                                          in a lcs of consious
     In addition !o sitring      rhe Helth Histny sctim with th€           LldlDpdrmra                                                            Individuals who rcquirc inslin for contol have @nditions
driw md onducting the physial mimtim,                         thc rediel   !3erJ(bx2)                                                             which m get out ofconFol by thc us oftoo trtch tr ts litllc
examim should diss             omn         ptwiptitr        sd ovq-thc-    A Fmn is physielly qulified to drive a comial                mtor      imlin. or food intak€ mt msktat           with thc imlin dmgc.
ounter mcdkntims rclatiw to thc sidc cffects md hurds of                   whicle if thd pcrsn:                                                   lrceacitatio    may GW &om synptoG of hyperglymic                   or
thw ncdiqtim             while driving, Edwar€ &iE                to md    H6 no itpimnt          oI: O ,1 hond or fugt      which inaerfea       hypogtpemic rcactons (drcsincs,                smi.mrioumcs'
ming        labcls on all trEdiqtioN. History ofstsin           mditioN    with prelwsion or pwr        gr6pirg: or (ii) An am,l@4 u leg          diabetic com c insulin slwk).
miy bc ere            for rcja*im,      partioldy        if tlquired by    which inurfw        with the ability to perlom rcmal t6ks                  Thc administmtim of inslin is, within itslf, a otrplicated
rcguldim, tr mry indiarc thc nccd fc additiml laborutory                   rcriotd      with oryroring a @Mial          motor whicle: or (iii)    proccss rcquiring inulin, syringc, rcdle, dcohol sponSc ud a
 tcsts or mrc stringort mimtim                 FhaF         by a nrdiel    Aay oller ignifuut      limb defut or linita{m wrtich irterlerc        stcrile t€hniqrc. Fectos Elatcd to lmg-hal             onmHpial
 sp€ialisl The dcbbtts ac usnlly nndc by ttrc rEdical                      with tla ilility    a perlom nomal usls asociatd              wilh     motor v€hicl€ opsations, uch r fatigrrc, lrck of slccp' pmr
 srnincr in liglr ofthc &iw'sirb         nsponsibiliticq uct sdtcdtlc      oryrating a oawrcial           mmr lehicle; or (iv) Hu been            dic! emtimal        conditim,    stsrss, md mcomitant        illns'
 md pmrtial fu dr mditirn o sdc thc &iu rrrsefc-                           grutd a &ill Puforue            Ewlution Certilicate Prffiant lo       compomd the diabaic problan. Thus, bcos                   of th€s
      Mcdicsl cdditim        should bc rsrd          dcn if dx.y ffi not   *aion 391.49-                                                           inhftnt dil8m,       thc FMCSA hG msisttrtly          held that a
 eus for dmial, and thcy slrould bc di*usred wilh tltc drivq                   A perm wto ruffc          los of a foot, lcg, hand c m or           diabaic wtn us          inslin for mtrol      dG nol ffit        thc
 to cn@uge          ppopriate      snedid       m.       This advice is    whe lird irpaimr             in my uy intqfcrcs with the gfc            minimm physical rcqrircmsts of thc'FMCSRs.
 espccially nccdcd wtm r ondition,                 if ncgleted, could      pcrOm           of rurul      tasks swieted      with opcnting a            Hypoglpmic         druga takm       onlly,   re    sffitim
 dcvclop into a sious       iuns that @uld rffoct driving.                 @trm.fcial mtor vchiclc is grbif,t to thc Skill Pcrfomc                 pmibcd      for diabctic indMduls io helP stimulat€ nstml
      lf th€ nrcdicd mmim         damines       rhar $c drivs is ft to     Evahntion (SPE) Cstification Prcgrm PuMr                 b stion        body production of insulin. lf thc @trdition cm bc mtrolled
 rhivc and is alm able !o perfm nor&iving rEsponsibiliti6 s                39 I .49, assming thc pcrm is othrwie qulified.                         by the w of crl medicetion ard diet, thm m individul may
 may be rcquired, rhc nrdiel            miner         sigts lhc nodical        With ltc tdvmmt             of technology, mcdical rids md          bc qualificd undc thc pr6€nt ru}e.
 certificate which tlre &ivcr trusr c{ry wirh hislbcr limse. Th€           equiptmt rrodificetions hrvc bm dffitopad to cqrpcnsrte                 (Sa Cofcme          R('ort e Di:baic Disdcrs sd Csmmid
  @rtificare mut bc datcd. Und€r mt                      rcgulrtims, rhe                                                              Prcgm         Drivm andlnslin-Using Cmial          Mora Vehiclc Drivm l:
                                                                           fc cqtdn diebilitirs.          Thc SPE Cettificetim
  certificate is valid fc two )t|rs, uls               thc driw hu a       (fornrrly thc Linrb Waivq Prcgram) % dcsigncd to .llow                   hcp://w-fmce-dot. gw/nlcsrcgr'radrports.hEn)
  mediel cqdition th.t do6 not prohibit driving but dos                    pcrms with thc los of a fmt c limb or with functional
  rcquirc rcrc frcquat mtitoring.             In ruh situatifis, the                                                                              C.rdiov*ulrr       Cordialon
                                                                           inTaimt       io qualiry undcr thc Fedcnl Motor Cuicr Safcty
  medisl certificare should bc isued fa a shottlr lqgth of                 Rcgulatim       (FMCSPS) by us of prcthctic dryicc                or   $39r..r(bx.)
                                                                                                                                                  A pcm       is phpically qulified to drive a @mtmial        rctor
  timc. The ph)6ial eruinatirn shorld be dolr aetuUy atxl 8t               cquiprmt nndifimtions which mablc thsn to sfely opsnt€ a
  lesi 6 @trddc s is indieted by the atacbod fqn Contst                                                                                           vehiclc if that pcmn:
                                                                           omial          mtor vchiclc. Sincc      drcrc re rc mcdiql aids
                                                                                                                                                  Hu no aneat clinical        diagnosis of mytardial     idarction,
  the FMCSA at (202) 3661790 ftr furrhq inffirndim (a visim                cquiEtat io ttc miginel body tr linb, ertain rists rc still
  exerptim, qualifying &iKs rtrd6 49 CFR 391.64, €tc)-                                                                                            a\gtnd pectoris, coronary imfrcienc)/,       thrcmbosis, or qny
                                                                           pr€snq md tbus ctrictions may be imMcd on individual
                                                                                                                                                  orhq cardiowelor          diseue of d wiety        btow     lo be
                                                                            SPE enifi€tcs       whcn a Stat€ Director fot the FMCSA
 Int rprctrdof, of Mcdlcel Steldrdr                                                                                                               accompanied by sytrcope, dyspnea, collapse or cong*tiye
                                                                            dctcrmincs llEy rc n$sery         to bc consistcnt with sfety and
 Sim the iscc       of be rraulatbro for physiel qrslifietims of                                                                                  hualailure.
                                                                            public intercst
 ffibl         &ivtrs,   tlrc Fedtral Mot(            Cmter Saf€ty                                                                                                                     clinical diagnosis of        is
                                                                               tf tlre drivs is found othwi*              mcdically qualificd        Th€ tcm "hs          rc cumt
 Administntion (ruCSA) h6 pbli$ed rwmrodati<m                  callod                                                                                                                     'a clinical diagnosis of'
                                                                            ({bx3) thugh (t3), thc mcdisl cxamiw 'rut chak                  specifically designcd to mcomprc:
 Advisry Critcia b hclp EEdi€l smilm                  in daanining
                                                                            q the mdial                                                           (t) r cumt cardiovmls          @tdition, or (2) a cardiowl8r
                                                                                              ceatificatc that thc drivff is qualificd only if
 ttfrdrqa &iv6mc€l3 tlE      physia! qutifietins      fry mial
                                                                            mnpanicd         by an SPE ccttifi@tc. Thc drivq and the              orditim which ha rct fully stabilizcd rcga(dlss of the tire
 &iving" The mtrFdatins            hm ban qdstscd to provide                                                                                      limit. Thc tm "kmm to bc mompanicd by" is dclincd to
                                                                            anrployng mior canis arc subjct to appmpriatc pcnalty if
 infqmtion b mcdical ffiin6         thal (l) is diEtly Eldail to OE                                                                               include: a cliniul diagneis of a cardiovsulu          dise      (l)
                                                                            the drivs opcntG s motor vehicle in intmtate ot forcign
 physicat minatim      and (2) is mt shedy irchd€d in th€ rEdisl                                                                                  which is accorirpmi€d by symptoru ofsyncopc, dyspnea,
                                                                            @|m          without r c|I|mt        SPE ertifrcete for hiVha
 minatim      fum Thc qocific rcgulatkn is printcd in italics ard
                                                                            phy$c8l dis$ility.                                                                                                            PaOe5 of 8
  iB refgac€ by s'tim is highlighted.
@llaps or Fngrstive erdiac failurc; md/or (2) which is                 (SocCofaw      m Pulmry/R6piarqy          Disdcrs rnd Conmid                             mst              ro thc hards of thcse nr€dicataons
likely to ew          syrcopc, dppcna, ollapsc m mgestive              Drit6.t: htrp://                    while driving Side effets of $moloc€               or syncope ar€
cardiacfailw.                                                                                                                                     pa{ticulilly undesinblc in omqcial        drivcrs.
    It is the intent of th€ FMCSRS to mdq uqrnlifrcd a driw            Hypcn riof,                                                                    Sondary       hyp€rtension is bascd m thc above stag6.
who hs          a cumt         wdbvaslr        dis*      which is                                                               Evalution is wmtcd          if petior is pcsistatly hypafasivc
accompmicd by and/or likely ro cNw symptoms of syncopc,                A Frsn is ph)6ic.lly q8alifiod to drivc . commi.l                mtor      on ruiml         or nar.mximl       dm     of 2-3 phmologic
dppnc4 collep* ot mngcstivc cudiec failm. Hwr,                   thc   vehiclc if thrr pem:                                                       ag@ts. Somc eus           of mndary        hypcrtmsion my bc
$bj6tive      dcisim      of wtctha thc naturc and sctrity        of   Hu rc unat       cliniml diagrcsis of high blod praw             likely    mdablc        to sugiel intwcalion      q specific phmologic
cardiowlar         inufficiacy     is on m indivkhnl besis od          to i$erfe    dlh ability to opratc a coilmercial w,or           whicle     disN.
qulification Bsts with thc nrcdiel qmirrr           and tE mtor        salely.                                                                    (Se Crdiowulaf         Advisory Prncl Guidclim fd thc Mcdicd
mis.        In tho* escs whcre thac is m m:                       of                                                                              Emitdion of Co'mid           Motd Vchick Driv6 8t:
                                                                            Hlpatmsim        elonc is unlikctf to ee          sudd€n collaps:
erdiovasulr                              (mycardial                                                                                               blts J/M.fffi   sdo(.gov/rulqqymcd.cpqts.htr)
                       imfrciacy                         infuctim,      hosts,     thc likclihood imrc&s wtra taryct orgm dmagc,
drombcis, ctc.), it is sggcstcd bcforc a driva b cctificd ttet          prrimlarly       ccbnl      Y|mlr        dirc,      is pffiL       This
hc\shc harc a normd rcsting End strs dectocdi<rgm                                                                                                 Rhcumtig           Alitrltlg        Ortbopcdc,         M[|cuhr,
                                                                        rwuldory dLrir          is bosed m FL{CSA'S Crdiovssls
(ECG), no roidul cqr4rlicrtim                                                                                                                     Ncurenrculer      or Vculrr     Di*rc
                                       rd rc physical limitatim,        Advisory Cuidclincs fq thc Eminatim                 of CMV Drivm,
md is tating rc mcdicati,on like ly io intaf,w wilt sfc                 thich rsd thc Sixth R.port of lhc loint N.ti@81 Comittc                   s3er.4l(bx7)
driving.                                                                                                                                          A pcMn is physiolly qulilied to drive a cmial           notor
                                                                        m D*ciion,          Enhntim,      md Tratment of High Blood
    Cmnrry {tsry bpass swgay ed prctmkd                                                                                                           whicle if thEtpcsn:
                                                      irplstrtim        Pcsm(1997).
m rcmcdial gwedus            ad ttrus, mt unqudifying Cannradin                                                                                   Hu no atablished tdiel       history or clinical diagwis oJ
                                                                            S rgc I h;petmsim        src+o*s         to I sFtolic BP of ll()'
is a mcdiHl tetmant vhidr m irprorc fhc tHl|h sd sfcty                                                                                            rtwri4      uthitic, orthopedic, mwqla4 nwlar               or
                                                                         159 mHg mdu e di.s.olic BP of 9G99 mHg. Thc drivq
of thc drivc ard sbNld rct, by its e, nodiolly disquli!                                                                                           welar    dkeue which intcdm        wilh abilily to Mtrcl nd
                                                                 Orc   .with e BP in this rrngc is rt lsy risk fu hpcrtcrsion-rctatcd
smcrcial       driva. Tbc crrylsis should be m thc urdalying                                                                                      operale a coilwcial   rctar vehicle safely.
                                                                        rutc imaprciotion ld nny bc mcdicrlly catified to drivc for
mcdical waditim(s) rftich GIuirc tlcaEnqrt {d s€ Scnaal                 r uc-yer pc'iod. Cqtificreion cnmimtions $ould bc dorc                        Cstain dis€es€s arc l(trom to havc mt€ cpisodcc of
haltb of rhc &ivq. Th€ FMCSA shdld bc urrr.*cd at (202)                 amrnlly ttEFflcr |tld should bc at or lcss thu 140D0. If lss               tnansicnt mu$lc wlsK,             pmr mlar           mrdinftion
366'1790 for additimd            rcqwmndatioro      rcpding      dE    dm l6Ul0O, qtifiatin             rrEy bc qtdlded onc rim for 3             (atuia), ebml         sasetions (pc6thesia), d@ras€d mlr
phpiol qulifietim         ofdrivm m oumadin.                           mndE.                                                                       lonc (hnoronia), visu.l distut€nG       and pain which my be
(Sc CqrfsBe m Cr.dir Di!q{6 rd C/m|Fid               DriE.t:                A blood prccsre of l6Gl79 srErolc ard/or l0G.l09                      suddaly inepacitarin& Widr cach Euning              cpisodc, thffi
ht9/fo w-fiKdot-govlrulc$cgvmcft?orts.hEn)                             diasaolic is msidcrEd Stagc 2 hypcrtcnsion, and tlrc driva is              symptonB my becorF rorc prcmccd                  md min         for
                                                                       mt wily             urqudificd duing cvalutio          ed instihnirn of    lmga periods of tim. Othcr diw              have mrc insidious
Raplntory     Dyrfirctior
                                                                       t|atmsrt     The drivq is giva a onc-tim cnificdtm                  of 3   on$ts md displ&y sFnplom or mdscle wasting (.tophy),
s3er.tlroxs)                                                           mnths to rcdE his c ha blood prsre                                         welling md prqrhaia          which may noFsuddcnly inoprcitarc
A pcrsn is phpically qurlifcd ro driv€ r mial                 nnts                                                        to ls the oi €qual
                                                                       to l/nr90. A blod pssm                 in this mgc is an ebsolutc          a pcrsn but my resfict hivbd mvelmts               ard wentually
whicl€ ifttstpssn:
                                                                       irdiatim       fu uti-lqpatemiw              drug hcrryy. hovided          intsfqe with th€ ability !o safely op€rst a trnttr vchiclc. ln
Hu m qablishd         ndical hisary or cliniel diagruis of a
                                                                       tqffit      is well tolmrcd rd thc &iv6 dcmon*d6                   e BP    tmy imtmes thw diseas re dcgcrrdstiv€ in natuc or
Bpimtory     dysluaioa      ltkeb to btefere wirt ability ,o
                                                                       nla of l:10E0 u lcss" hc or shc my bc ccrtificd fc m )ar                   my mult in dcterioratim of the involved rea-
coa!rcI ud driye a awial          mtor vehicle safely.
                                                                       ftom datc of the initid cm. Thc driw is mtificd mually                         Oru thc individul         hr ben diagnosd I hrving a
   Sire a dris      trnst bc alqt at dl tirc,        my clmge in       tlaqfts.                                                                   rhcumatic, arthritic. orthapcdic, munlu,      ncuwler            or
his\hq mtal     stat is in dirccd Mflicr with highmy saftty.
                                                                           A blood pwrc.t           or gEt6 the 180 sF{olic and ll0               wler       diw,     tha hdshc bs m etablished history of that
Evm th€ slightst in{nimt           in r€spintory fimction mdq
                                                                       diesrolic is aoosidsrd Stagc 3, high risk for m mtc BP-                    diw       Thc physiciu, wha mmining il individul, should
cnETgmcy mditios           (wbm grl f6 oxygor zupply is
                                                                       rclird    Gmt        Thc dtivs my mt bc qulificd,                  am      mnsider thc following: (l) th€ marrc aod wity              of the
nessary fm pcrforme)          may bc d€t]ilmrrl     to sfe driving     taqowily,       mtil rcduccd to 140190 or las and traomnt is               individual's condition (such 6 sn$ry           los or loss of
   Thsc m lmy          cmditions rhat interfcrc with ox16a             wcll tolcnt€d. Thc dris my bc ccrtificd fc 6 mnths and                     strcngth); (2) ttF dcgrc of limitatim pmt       (wh s mg" of
exchmgc nd         my     rcult   in in€pacitatim,        irchding     biuually      (ffiry 6 mths)         lheBftcr if er rchcck BP is           nption); {3) thc likclihood of prcgffiiw          limitrtkm (not
ctrphyscm, chmnic asthnra, cmimnr,          tubemlosis, chronic         140D0 orlx.                                                               always pmt       initially but my mnifest i6clf ov6 tirc); md
bronchitis, and slc€p apncl. lftlE m.dic.f qamim dctecrs a
                                                                           Annul rccatificrtion        is umdcd                if thc mcdial      (4) thc likclihmd of sudda incapacitation. If sevw fimctioml
r€spintory dyrfuncliorl ther in my way is likely to int6f@
                                                                       ffiim       dG not b|ow the waity              of hwcnmsion prir io        itr|pai|]mt qisfs5 thc drivcr dm not qudiry. In rc          wherc
with the driver's ability to efcly conlml and driv€ a
                                                                       tBtrEnt-                                                                   mrc fiEqlmt mnitoring is rcquired, a certifiere for e shortq
comial       mofor vehiclc" lhe &ivcr mst b€ rcfncd to a
                                                                           An clcv.t€d blood Fcwrc finding should bc ufrmed                  by   tire p6iod my bc iscd.
spsirlist for firthq walutim        ild th€npy. Aniic@gulatim                                                                                     (S€ CqfcHcc o Ncunlogial Disdc6 srd Com|rmial Driv6
                                                                       at lasl trc $b6eqmt remts                     m diffmt     &ys.
th@py     fq    dccp vcin tfiornbcis          ild,/u     pulmary                                                                                  il: htQ://|&gvhedEpffi       .hm)
                                                                           Tfarmt        imhrde nmphamologic              md phrclogic
tbrcmbcmbolism is oot mquli&ing           once optimm dosc is          modelitia 6 wcll s cwling                to rcdw othq risk frctoro.
mhieed, prcvided lowa extrcmity vmus                  €xaminations     MGt eti-hlDcrtsirc           modieti<ru alp havc side cfiocts, thc
remin nonnal md the trating pfunidm giva a favmble
                                                                       importrre of which mu$ bc         jldgcd m a iDdiyidul basir
rromcndatiq.                                                                                                                                                                                          Pag€ 0 of 8
03er..r(bxt)                                                                   s3el..r(bxe)                                                                         S39l.,ll(bXl0)
                                                                                                                                                                    A pernn is physially qutified ro drive a comrcrcial motor
                                                                     mtor      A pcrsn is physiolly qulified ro driw a cmmial                            mtot
A pcrmn is ph)6i6lly qulifed to driw a €mmi8l
                                                                               vehicle ifthal pcrson:                                                               vehicle if that prun:
vehicle ifthat perrcn:
                                                                               H6 no mentaL rcM,                    orgmic or lwliorul            diswe or          H6 dislant vbwl acuity olu leut 20/40 (Srella) in eoch eye
Hu no utablished medial history or clirical dregws of
                                                                               psyhtutric disorder lilaly o inkrlere wirh ability Io dive a                         wilh or |9ilh@, Nfr.clive Ima or viwl aeity separolely
epilepry or any ortq cndition which b li*ely to awe lw of
                                                                               comeial          rctor vehicle sa{elY.                                               corec,ed b 2A/40 (Snellen) or beller with coftectiw le6es'
 rcwioun*         u any los ol abilily to conarcl a wlor whiclc-
                                                                                                                                                                    dliladl bir@vlar @iry of at I6t 20/40 (Swilen) in both eyes
     Epilepsy is a chrcnic finctimal disre             charutaiad        by          Emtionat or adjuscncnt problm contributc dirwtly to e
                                                                                                                                                                    with or wilhou, corelile        leas, feld d visim of at lrct 70
                                        withet wErninS, mltint            in    individual's lcvel of mantry,                  rcmning         anmrim sd
wizum or €pfuodcs thrt ffi                                                                                                                                          degms ia the horiutal         reidiu    in uch eye' sad ,he ability
loss of voluntary siEol             wfiich my         h.d     b loss of        judgrmr- Th6c Froblm oftcn underlic physical disordm. A
                                                                                                                                     y'mmincs, dizins'              lo r@ogaize rhe @lorc of trafrc aiSwls and devire showing
consiosncss ad/or sirc.              Tlraefme,    the followhg drim             Ericty of functiml dimdm m euse 'that
                                                                                                                                              my      lcrd to        the standard red, grea, atd amher.
mrot bc qualificd: (l) i drivd Yto hrs e mcdiol hi*ory of                       onfusion.        mskn6           or pa'alysis
                                                                                                                                                                                    'ebility to reognir the colos of is intcrprEtcd
                                                  clinicel diagncis of          ircmdin*im,            iiln6ti6,       los of fumtimal mtrcl                lnd         Thc tm
cpilcps),; (2) a dris who hs a mt
                                                                                su*cptibility       to uidcns         vhilc &iving. Physirl fatiguc'                to mn       if a pcrsn cm wgnire            md distinguish among
cpil€psy; or (3) a &iYa who is teking mti.rciarc di€tim.
                                                                                hadache, irryaircd codinaticl                 recuning     physiel ailms            baffE 6nhol sigmls md dryic drowing stsndsrd red' grem'
     lf m individrat hs had a sddat cpisodc of m<pilcptic                                         'nagging' pain my be p(ent to smh a degrc
                                        of mbrwn        rc      which did       md chrmic                                                                           and mbs, h.y'she rers thc minimum st ndad, ad though
sizw! or bcs of cotrsciffi
                            rrrdistion, thc dccisim s to thc6a                  thrt stifiotim             for omcial             driving is inadvisblc.            hc\shc my hrvc src typc of color pqccPtion defciency- If
not rcquirc mti-*im
that p€rson's cqdition will likely causc lcs of             wio||ffs            Somtic and pd)rchosmtic omplsints shold bc lttomghty                                cdtain 610r pcrccptim tcsts are a&ninistqcd, {such u
                                               vdtblc fu nndc m an              cr.mhcd ddsmining m indiYidual's ownll fitrcss to                              tshihan, Psdoiwhrcmtic,             Ym) md dorStful tindings ue
or los of ability to mtsol s mlr
 indivirfual bcis by thc nrcdial miE               in cdarlt tid with           &iw- Disordc of e paiodicelly incqcilrting                     nrnIo, cvcn in       disowrrd, a @ntrolled r6t using signal rud. grem and amber
 the trating phFicin       Bcfq€ €rtifiotioa         is midercd,       it is    thc aly stegs of &vcloFlnq                 my mt            disquliliotim.          my bc cmployed to dc*mim th€ driYcr's sbility to rcognia
                                                                                     Mmy b6 md truck drivcrs hevc dmmcntcd thal "n€ns                                ths colos.
 suggpscd that a Gmontl miting p6iod d.P$ tom thc tim
                                                                                              rclatcd lo norotic,             pcrsonality, anntioml            or        Contrct lms rc pcmissiblc if thrc is sfficiat        wid€nce
 of rhc 4isode. Following tL *iting paio4 it is sggc*ed                         lror$le"
                                                                                 adjBffit      problem is rcsponsiblc for r siSnificant frection of                  to indiste that thc driva htr Eood tolme             md is wall
 thst thc individual harc . ffiplctc mrmbgnat cminrtioo.
 lf thc Gults of tlrc mimtim             rc ncgltirc rnd mti-*iare               rhir prcwrtrblc cid€ns.             Thc dcgrc to wtich m individul                  ad.ptcd to iheir uw- U$ of a contact lms in onc cye for
 modicrtim is not rEquirc4 ttm thc &ivs my bc qulifcd-                           k rblc to Tpreitfic,            walugc and ldcqurtcly rtsDond to                    distane visurl rcuity md anotha lms in the otha cyc for nar
      Ia thwindividml     crgwhc           adriwhs         r rimcm               ffhonlmntsl          srain od enrotionel srrss is diriel                  whca      vision is rct aecptf,blc, nor tclescopic lascs acceptablc for
                                                                                                                                                                     thedrivingofmialnPtmvehicla.                    !
 episodc of loss of mioune                    thrt Hltcd          tDm m          aseing       m individual's mtal              alaOrs 8d llqibility            ro
 unlcmm        modical curditim          (c.9, &ug t@im,               high      copc wilh thc stwsofcmid                        mtor vebich &iving                      tf m individul rEts the ritsia by the u* of glresc or
  tcrnparnrc, rculc infctioE           diss.,    dchldntion tr lste                  V/hm amining            the driva, it should be k@t in miDd that                cotrtact lffi,      the following statcrmt shall appcu on thc
                                                                                                                                                                                                           *Qualificd only if wcuing
  maabolic distubrM),         cqtification slnld bc &fcrrcd until                indMduls who liw unds chmic crptiooal upsts my                                 Mcdiel Exmincr's Ccrtificalc:
  the drivq hr firlly lwvacd          tom thrt onditim md ha rc                  dcply ingnincd nnladrytirc q mtic                        behavior pasms.            corrctive lms".
                                                                                                                        instirrctivc, inpulsivc,         opcdy       (S@Cofffi         o PsjrchialticDisrdcs .rd Cmial        Drivm at:
  cxisting rcidurl mnplications, ard not tsking rnti4izurc                       Exmsivcly          utagonistic,
                                                                                                                                                                     htlp://w.ft rcs.dd. gov/rulcsrrgy6cdrcpods.   htm)
  mcdication.                                                                    .ggrcssivc, pmoid             or *vctlly      depcscd bchevior gmtly
  (Sc CqfquE        o Cgdirc Di$idqs od Cmmid                    Ddv@ rt:         intcrfcrc with lhe drivs's ability to driw sfcly. Thosc
  hup/lw.     fies.dotgovlolcwgCncdrports.lm)                                    individmls who m highly srccptible to filqudt                         st tG of     Hurhg
                                                                                 mtioml          insability      (rchiaphmia,          affetive     Ps]rclffi,      $091.4t(bxlr)
                                                                                 pamia"        axity         or dcprcsivc ws)                   my wrot             A perwn is physically qulified to drivc a comrfficial motor
                                                                                  disqulifistim.         Cwful msidmtion            should bc givm to rhe           vchicle if that Frw:
                                                                                  sidc efu          md intretims          of mcdications in tbs ovaall              First perceiw a lorced whispered wice in the betler eor at
                                                                                  qulifiatirn      dcEmimtim.         Sc Ps!rchiatic Cmfcms              Rcport     not t6s ,han 5 feet wiah or wi hw, the 6e of a hearing aid, or,
                                                                                  for speifc rEcomf,Erdaliqs m thc u* of th* nEdicatims                             rf tated by ue of an ordiometric dqice' dus not haw M
                                                                                  md potqrtid lnzrds for drivinS.                                                   alerage heaitg loss in the bilter qr greater thsn 10 decibels
                                                                                  (SocCrfqacc m P*shirtric Disdqr rnd Cgnffiid                        Ddvw rt:      st 500 Hz, !,Nn Hz, and ZmO Hz with or wi.hout o hearing
                                                                                  hf,prirw.trH.dor.$v/rulsgdmc&?qlr.ltn)                                            aid whq the adioretic        dqice is calibrated lo Arcrican
                                                                                                                                                                    Notiuol Standud (omerly 'LDA Sandard 224 5- I 95 I .
                                                                                                                                                                        Sire thc preribcd    standtrd udd thc FMCSRS is the
                                                                                                                                                                     Almim     SLndsrds Assciation (ANSD, it my bc nsesaD.
                                                                                                                                                                     to convqt thc audiomcqic rcslts ftom thc ISO stand{d to thc
                                                                                                                                                                     ANSI srand{d. lnsErrctiqs rc ircludcd on thc Medical
                                                                                                                                                                     Exminatim rcpori fm

                                                                                                                                                                                                                         Page 7 of 8
                                                                                    'habit-fomint"    is inlcnd€d lo incldc any drug or
    If m individul mets the aitctia by using a hming aid, thc           Thc tem
                                                                        mcdietion gaoally          mgnizrd     * c4ablc of btroming
driv6 must war that huing rid and have ir in optrttifi at all
timcs wtile dtiving- Ale, thc driver must be in posscsim of a           habilul ond wtrich may impair the usr's ability to opcBt€ a
sparc pow sure for thc haring aid'                                      ommcrcial mtor vehicle ufclY.
    Foi ne *'hispeftd voie test, thc individual should bc                   Thc drivq is nrcdicelly unqualificd for the duntion of the
                                                with lhc o bcing        prohibitcd drug(s) u$ rnd until a smd           ffiinrtim      shos
stationcd at lctst 5 fccr from thc cmins
t6ted tmed tovard thc emins.             The otts a is owred'           ifr" d.iro      is frcc tom &c prolribitod &ug(s) u*. Re
                                     rfta a rcrmal xpiration, thc       stificetion      may inwlrc . $bEttm         abw      wduation, the
Using thc bsth wtich mins
cxmins wlrispcrs thc words ot rmdom numbas sch c 66,                    sucsful       conplaion of a drug ehabilitation pmgnr4 ard a
                                  should lpt w       mly sibilsrts      ncglive       dnrg   t6t r€sull Additionatly'        givn   drat the
 18, 23, elc. The cxmirr
 (s-sounding mtcrials). TIE opPositc d sbould be tcttd in drc                           pctioa is mrmlly two yrc, tlE €min€r hs lhe
                                                                         optim to ccrti$ for a paiod of le than 2 year if tiis cminu
 surE manns. If frc indMdud frils drc whispcrcd voiE tcst'
                                                                         dctsmine m          frqwrt mitoring     is rcqui*d.
 lhc audidlletric tat should bc a&ninistrcd.
                                                                         Sc Coieme         o ttaing Diud6       rd Cm@id          I)riY6 rt:
     If en individual metts thc citcria by thc u* of a hering aid'
 the following strtlrmt    mst 4pcar on dr€ Mcdicsl Enmincr
              *Qualifted only whcn wuing a hcaring aid."
  (S€ Hciog DtddEs sd Crcid                Mqtd Vdicb Dtii6 't:         Akel&m
  hq/ft|Esddgpv/rulacgr'mc@httr)                                  039LllOXt3)
                                                                        A panon is physically qoElifi€d b drirc a cqmwial            motor
DngU*                                                                   vchir:lc if that pctw:
s39r..l(bx12)                                                           Hu rc smt          clinical diagnuis of aloholism.
rl, pcmn is phpielly       qBslifiod to driw r mmsciel        rnotm                      'cumt
                                                                            Thc t€rm                 clinical diagnosis of is spccificdly
veiiclc if thrt Fm:                                                                                    I crtcnt doholic     illms c thos
                                                         in 2l cFR      ddigEcd to 6mPas
hes      nol use a mtrclld        suhsmne idatilid
                                                                        inslecs      whcrc rhc indivirlual's physicl conditim h8 not
I 308- t - Mrdule I, an aaphetamlre' a wmtic'
       I                                                or aay orter
                                                                        fully *ebiliad, regrdls          of thc tiru clcnmr If m iadividual
habirfoniagarug.         Erceptiu: A driw         nay we reh a
             q dnt, if thc stbsuw        or drug b prcseibd by a        show slgns ofhaving m alcohol-re probbrn hc\$hc shilld bc
subnw                                                                                                                      ed/or tratMt,
                                                   ||ith tlc driler's   rcfmd       to I spcialist. AOer mling
licelsed wdial     qrctitiuzr      vho is fuiliar
                                                                        hcbhc my bc msidqcd fr cstifietion.
rcdiaal hisbry and Nigned duri6; ond has o&isd the driw
lho, the pr*cribei     xbstnce or drug will rct adwety afet
tfu Mier's      ability to salety optrate o c@rercial          motq
     This exc€ption docs mt sPply to nratadma. ThG int€nt of
 the medical ccrtificatc Proccs is to mcdicdly svaluatc a drivr
 to cns€ that lhc drivcr hx no medical cotditim vhich
 intcdcres witi the safc pafrrrnnce of driving trsks on a Pr$lic
 mad. Ife driver lm a Schcdulc I drug or odts substancc' an
 arphcuminc, a nuotic, or my other babit-foming drug it
 *i    be caw for the driw to be found rEdk:lly mCualifi€d-
  Mottr carri6 arc doungcd to obtain a pfftitims's       wittm
  statemt rbout ttc effccts o umsportatim safcty ofthe E of
     A test for mtrollcd $bstanc6 is not r€quired u put of this
  biennial ccrtifimtion proc€ss. Thc FMCSA ot {E drivtr's
  emptolci should be ontactcd dirwtly fc infomtim
  controlled substanccs md dcobl t€sting llds Pafi 382 of tbe
      Th€ term 'lrs'   is d6igDcd to 4mpsss        instrnc€s of
  prohibited drug use detmincd        by a physician thmgh
  istablished modical m.     This my   d mty rct involw body
  fluid testin& ff body fluid testing takc plre, positiw test
  reslts should be confimcd by a wd             te$ of gmtq
                                                                                                                                               Prge I of I

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