Medical Regulations and Guidance Resource Links
About the Tables
This document provides quick access through links to the Federal Motor Carrier Safety Regulations relevant to the physical qualification of interstate commercial motor vehicle (CMV) drivers as well as other available resources including Medical Review Board taskings and recommendations, and evidence reports.
Regulations vs. Guidance
Established under the Agency’s statutory authority, FMCSA’s safety regulations concerning the physical qualifications of drivers are legally binding on those subject to their provisions. FMCSA has the authority to compel compliance with regulations. These regulations ensure uniform application of the law and how the laws must be followed.
In addition, FMCSA provides medical guidance to Medical Examiners (MEs) in the form of advisory criteria, bulletins, interpretations of the regulations, and guidelines. Medical guidance assists MEs in applying the regulations governing the physical qualifications of interstate CMV drivers. Often, this guidance is based on input from medical expert panels or is derived from clinical best practices. Unlike regulations, recommendations and other guidance do not have the force and effect of law and are not meant to bind the public in any way. Rather, such guidance is strictly advisory, not mandatory, and intended solely to clarify existing requirements under the regulations or FMCSA policies. The public (including MEs) is free to choose whether or not to utilize such guidance or recommendations as a basis for decision-making.
The links below include sections from the Federal Motor Carrier Safety Regulations (FMCSRs) that are applicable to the physical qualification of interstate commercial motor vehicle (CMV) drivers.
Title |
Citation |
Description |
National Registry of Certified Medical Examiners |
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Scope. | 49 CFR 390.101 | Overview of 49 CFR 390.101-115. |
Eligibility requirements for medical examiner certification. | 49 CFR 390.103 | Provides requirements for becoming a certified medical examiner on the National Registry. |
Medical examiner training programs. | 49 CFR 390.105 | Provides requirements for training organizations and lists the core curriculum. |
Medical examiner certification testing. | 49 CFR 390.107 | Provides the criteria that testing organizations must meet. |
Issuance of the FMCSA medical examiner certification credential. | 49 CFR 390.109 | Describes when a medical examiner will receive certification, and the length of certification. |
Requirements for continued listing on the National Registry of Certified Medical Examiners. | 49 CFR 390.111 | Provides requirements for medical examiners to maintain their certification and listing on the National Registry. |
Reasons for removal from the National Registry of Certified Medical Examiners. | 49 CFR 390.113 | Provides reasons a medical examiner may be removed from the National Registry. |
Procedure for removal from the National Registry of Certified Medical Examiners. | 49 CFR 390.115 | Describes the methods of removal from the National Registry, and the accompanying process for each method. |
Medical Examiner Certification Requirements for Qualified |
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Medical examiner certification for qualified Department of Veterans Affairs examiners. | 49 CFR 390.123 | Provides requirements for becoming a certified Veteran Affairs (VA) medical examiner on the National Registry. |
Qualified VA examiner certification training. | 49 CFR 390.125 | Provides requirements for qualified VA examiner certification training. |
Qualified VA examiner certification testing. | 49 CFR 390.127 | Provides requirements for qualified VA examiner certification testing. |
Issuance of the FMCSA medical examiner certification credential. | 49 CFR 390.129 | Describes when a VA medical examiner will receive certification, and the length of certification. |
Requirements for continued listing of a certified VA medical examiner on the National Registry of Certified Medical Examiners. | 49 CFR 390.131 | Provides requirements for VA medical examiners to maintain their certification and listing on the National Registry. |
Reasons for removal of a certified VA medical examiner from the National Registry of Certified Medical Examiners. | 49 CFR 390.133 | Provides reasons a VA medical examiner may be removed from the National Registry. |
Procedure for removal of a certified VA medical examiner from the National Registry of Certified Medical Examiners. | 49 CFR 390.135 | Describes the methods of a VA medical examiner removal from the National Registry, and the accompanying process for each method. |
Physical Qualifications and Examinations |
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Physical qualifications for drivers. | 49 CFR 391.41 | States which drivers must carry a medical certificate, and sets out the physical qualification standards. |
Medical examination; certificate of physical examination. | 49 CFR 391.43 | States who may conduct examinations, which forms must be used to record results, how long to retain forms, and when to report to FMCSA. |
Persons who must be medically examined and certified. | 49 CFR 391.45 | States who must be examined by a certified medical examiner listed on the National Registry. |
Physical qualification standards for an individual with diabetes mellitus treated with insulin for control. | 49 CFR 391.46 | Provides the requirements for drivers with diabetes mellitus who are treated with insulin for control. |
Resolution of conflicts of medical evaluation. | 49 CFR 391.47 | Provides the requirements to apply for resolution of a conflict between a driver’s and motor carrier’s medical examiners. |
Alternative physical qualification standards for the loss or impairment of limbs. | 49 CFR 391.49 | Provides the requirements for drivers seeking a Skill Performance Evaluation (SPE) Certificate, and that drivers with an SPE Certificate may be medically qualified. |
Limited Exemptions |
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Limited exemptions for intra-city zone drivers. | 49 CFR 391.62 | Provides the requirements for drivers to be exempted from the age restriction and certain physical standards. |
The links below are provided as a resource for information sharing and do not constitute regulatory standards; rather, they provide the ME medical information to consider when making a physical qualification determination.
The evidence reports included in the links below reflect the views of the authors, who are responsible for the facts and accuracy of the data presented at the time the expert reports were originally released. The contents do not reflect the official policy of FMCSA.
Title |
Topic |
Date |
Description |
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Medical Advisory Criteria |
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Medical Advisory Criteria |
December 13, 2016 |
Medical Review Board’s (MRB) recommended revisions to the Medical Advisory Criteria. |
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Medical Advisory Criteria |
January 19, 2024 |
Published as an appendix to part 391 of the CFR, contains non-regulatory guidance to assist medical examiners. |
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Medical Examiner's Handbook 2024 Edition |
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Medical Examiner's Handbook 2024 Edition | Medical Guidance | January 22, 2024 | The Medical Examiner's Handbook provides information about regulatory requirements and guidance to medical examiners listed on FMCSA's National Registry of Certified Medical Examiners who perform physical qualification examinations of interstate commercial motor vehicle drivers. | |
Sleep Disorders |
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Final MRB Task 16-01 Letter Report from Motor Carrier Safety Advisory Committee (MCSAC) and MRB | Sleep Disorders | November 21, 2016 | MRB recommendations regarding comments received on Advanced Notice of Proposed Rulemaking (ANPRM) on obstructive sleep apnea. | |
MRB Task 16-01 Draft Letter Report | Sleep Disorders | August 26, 2016 | MRB recommendations to the ANPRM on obstructive sleep apnea. | |
Sleep Disorders |
August 23, 2016 |
Draft discussion notes and MRB recommendations on obstructive sleep apnea. |
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Obstructive Sleep Apnea and Commercial Motor Vehicle Driver Safety: Updated Review | Sleep Disorders | November 30, 2011 | Evidence report synthesizing research conducted since the 2007 evidence report on obstructive sleep apnea. | |
Obstructive Sleep Apnea and Commercial Motor Vehicle Driver Safety |
Sleep Disorders |
November 21, 2007 |
Evidence report presenting findings regarding obstructive sleep apnea and commercial drivers. |
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Medication/Drug Use |
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Medication/Drug Use |
October 25, 2016 |
MRB discussion notes and recommendations regarding FDA warnings on narcotics and benzodiazepines. |
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Federal Register Notice on 391.41 CMV Driver Medication Form, MCSA-5895 | Medication/Drug Use | July 8, 2016 | Federal Register notice announcing the 391.41 CMV Driver Medication Form, MCSA-5895. | |
MRB and MCSAC Joint Task 14-3: Schedule II Controlled Substances and CMV Drivers |
Medication/Drug Use |
December 16, 2014 |
Final revised MRB recommendations on Schedule II substances and commercial drivers. |
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MRB Task 13-01: Schedule II Controlled Substances and Commercial Motor Vehicle Drivers |
Medication/Drug Use |
October 13, 2014 |
Draft revisions to MRB recommendations on Schedule II controlled substances and commercial drivers. |
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Medication/Drug Use |
October 22, 2013 |
MRB recommendations on Schedule II substances and commercial drivers. |
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Licit Schedule II Drug Use and Commercial Motor Vehicle Driver Safety |
Medication/Drug Use |
October 21, 2006 |
Evidence report presenting findings regarding medication/drug use and commercial drivers. |
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Public-Private Partnerships |
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Public-Private Partnerships |
August 10, 2016 |
MCSAC draft discussion notes and recommendations on public-private partnership activities. |
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Public-Private Partnerships |
September 21-22, 2015 |
MCSAC and MRB draft discussion notes and recommendations on public-private partnerships. |
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Diabetes |
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Diabetes |
May 19-20, 2021 |
Draft MRB recommendations regarding the proposed Non-Insulin-Treated Diabetes Mellitus Assessment Form |
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Diabetes |
September 1, 2015 |
MRB recommendations regarding comments on the Notice of Proposed Rulemaking (NPRM) on insulin-treated drivers of commercial motor vehicles with diabetes mellitus. |
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Diabetes |
May 27, 2011 |
Evidence report with updated information regarding diabetes and commercial drivers. |
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Diabetes |
September 8, 2006 |
Evidence report presenting findings regarding diabetes and commercial drivers. |
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Vision |
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Vision |
May 19-20, 2021 |
MRB recommendations regarding proposed alternative vision standard and Vision Evaluation Report Form. |
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Vision |
September 1, 2015 |
MRB recommendations on FMCSA’s vision standards for CMV drivers. |
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Vision |
June 6, 2008 |
Evidence report presenting findings regarding vision and commercial drivers. |
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Hearing |
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Cochlear Implants and Commercial Motor Vehicle Driver Safety |
Hearing |
October 29, 2010 Revised January 14, 2011 |
Targeted evidence report presenting findings regarding cochlear implants and commercial drivers. |
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Hearing |
August 26, 2008 |
Evidence report presenting findings regarding hearing and vestibular disorders and commercial drivers. |
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Traumatic Brain Injury |
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Traumatic Brain Injury and Commercial Motor Vehicle Driver Safety |
Traumatic Brain Injury |
March 30, 2009 |
Draft evidence report presenting findings regarding traumatic brain injury and commercial drivers. |
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Stroke |
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Stroke |
September 15, 2008 |
Executive summary to evidence report presenting findings regarding stroke and commercial drivers. |
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Psychiatric Disorders |
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Psychiatric Disorders and Commercial Motor Vehicle Driver Safety |
Psychiatric Disorders |
August 29, 2008 |
Evidence report presenting findings regarding psychiatric disorders and commercial drivers. |
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Movement Disorders |
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Parkinson’s Disease, Multiple Sclerosis, and Commercial Motor Vehicle Driver Safety |
Movement Disorders |
June 3, 2009 |
Evidence report presenting findings regarding Parkinson’s disease, multiple sclerosis, and commercial drivers. |
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Musculoskeletal Disorders |
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Musculoskeletal Disorders and Commercial Motor Vehicle Driver Safety |
Musculoskeletal Disorders |
May 29, 2009 |
Evidence report presenting findings regarding musculoskeletal disorders and commercial drivers. |
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Seizures |
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Seizure Disorder and Medical Certification of Commercial Motor Vehicle Driver Safety (2019) |
Seizures |
March 2019 |
Update to 2007 evidence report presenting findings regarding seizures and commercial drivers. |
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Seizure Disorders and Commercial Motor Vehicle Driver Safety |
Seizures |
November 30, 2007 |
Evidence report presenting findings regarding seizures and commercial drivers. |
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October 15, 2007 |
Expert panel recommendations regarding seizure disorders and commercial driver safety |
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Kidney Disease |
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Chronic Kidney Disease and Commercial Motor Vehicle Driver Safety |
Kidney Disease |
November 5, 2007 |
Evidence report presenting findings regarding kidney disease and commercial drivers. |
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Cardiovascular Disease |
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ICD |
December 17, 2014 |
White paper regarding research on implantable cardio defibrillators and the impact of a shock to the patient when deployed. |
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Expert Panel Recommendations – Cardiovascular disease |
Cardiovascular Disease |
June 5, 2013 |
Expert Panel Recommendations - Medical Examiner Physical Qualification Standards and Clinical Guidelines for Cardiovascular Disease and Commercial Motor Vehicle Driver Safety | |
Cardiovascular Disease and Commercial Motor Vehicle Driver Safety |
Cardiovascular Disease |
April 27, 2007 |
Evidence report presenting findings regarding cardiovascular disease and commercial drivers. |
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Skill Performance Evaluation (SPE) Certificate |
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Krusen Study on Limb Prosthetics | SPE | April 1977 | Study regarding limb prosthetics for the SPE certificate program. | |
FMCSA Research Projects |
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Research Brief - Examining the Seizure Standard for Commercial Motor Vehicle Drivers | Seizure | June 1, 2023 | Research brief regarding the study on the seizure standard. | |
Examining the Seizure Standard for Commercial Motor Vehicle Drivers | Seizure | June 1, 2023 | Evidence Reports, Systematic Review, and Medical Expert Panel Report regarding the seizure standard. | |
Effect of the Length of Medical Certification on Safety | Research | February 1, 2023 | Study to evaluate the relationship between the duration of CMV drivers’ medical certification and crash and/or violation risk. |
The links below are to each of the forms used during the physical qualification of interstate commercial motor vehicle (CMV) drivers examination.
Form | Description |
Insulin-Treated Diabetes Mellitus Assessment Form, MCSA-5870 | This form is required to be completed for drivers who have insulin-treated diabetes mellitus by their treating clinician and must be evaluated under 49 CFR 391.46. |
Vision Evaluation Report Form, MCSA-5871 | This form is required to be completed for drivers who have monocular vision, as defined by FMCSA, or do not meet FMCSA's vision standard, by their ophthalmologist or optometrist. |
Non-Insulin-Treated Diabetes Mellitus Assessment Form, MCSA-5872 (optional) | This optional form can be used to request additional information from a driver regarding their diagnosis, monitoring, and stability of non-insulin-treated diabetes mellitus to determine if the driver is medically qualified per 49 CFR 391.41. |
Medical Examination Report Form, MCSA-5875 | This form is required to record the results of the medical examination performed on each driver. |
Medical Examiner's Certificate, Form MCSA-5876 | This form is required to be completed if a driver is found to be medically qualified and should reflect the same qualification decision indicated on the Medical Examination Report Form, MCSA-5875. |
391.41 CMV Driver Medication Form, MCSA-5895 (optional) | This optional form can be used to request additional information from a driver regarding their medications prescribed by their treating clinician for a medical examiner to use in determine if the driver is medically qualified per 49 CFR 391.41. |