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  • § 391.2
    General exceptions.
  • § 391.11
    General qualifications of drivers.
  • § 391.15
    Disqualification of drivers.
  • § 391.21
    Application for employment.
  • § 391.23
    Investigation and inquiries.
  • § 391.25
    Annual inquiry and review of driving record.
  • § 391.27
    Record of violations.
  • § 391.31
    Road test.
  • § 391.33
    Equivalent of road test.
  • § 391.41
    Physical qualifications for drivers.
  • § 391.43
    Medical examination; certificate of physical examination.
  • § 391.45
    Persons who must be medically examined and certified.
  • § 391.47
    Resolution of conflicts of medical evaluation.
  • § 391.49
    Alternative physical qualification standards for the loss or impairment of limbs.
  • § 391.51
    General requirements for driver qualification files.
  • § 391.63
    Multiple-employer drivers.
  • § 391.65
    Drivers furnished by other motor carriers.

Part 391

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View the regulations for Part 391

Guidance for § 391.43: Medical examination; certificate of physical examination.

Question 1: May a motor carrier, for the purposes of §391.41, or a State driver licensing agency, for the purposes of §383.71, accept the results of a medical examination performed by a foreign medical examiner?

Guidance: Yes. Foreign drivers operating in the U.S. with a driver’s license recognized as equivalent to the CDL may be medically certified in accordance with the requirements of part 391, subpart E, by a medical examiner in the driver’s home country who is licensed, certified, and/or registered to perform physical examinations in that country. However, U.S. drivers operating in interstate commerce within the U.S. must be medically certified in accordance with part 391, subpart E, by a medical examiner licensed, certified, and/or registered to perform physical examinations in the U.S.

Question 2: May a urine sample collected for purposes of performing a subpart H test be used to test for diabetes as part of a driver’s FHWA-required physical examination?

Guidance: In general, no. However, the DOT has recognized an exception to this general policy whereby, after 60 milliliters of urine have been set aside for subpart H testing, any remaining portion of the sample may be used for other nondrug testing, but only if such other nondrug testing is required by the FHWA (under part 391, subpart E) such as testing for glucose and protein levels.

Question 3: Is a chest x-ray required under the minimum medical requirements of the FMCSRs?

Guidance: No, but a medical examiner may take an x-ray if appropriate.

Question 4: Does §391.43 of the FMCSRs require that physical examinations of applicants for employment be conducted by medical examiners employed by or designated by the carrier?

Guidance: No.

Question 5: Does a medical certificate displaying a facsimile of a medical examiner’s signature meet the "signature of examining health care professional" requirement?

Guidance: Yes.

Question 6: The driver’s medical exam is part of the Mexican Licencia Federal. If a roadside inspection reveals that a Mexico-based driver has not had the medical portion of the Licencia Federal re-validated, is the driver considered to be without a valid medical certificate or without a valid license?

Guidance: The Mexican Licencia Federal is issued for a period of 10 years but must be re-validated every 2 years. A condition of re-validation is that the driver must pass a new physical examination. The dates for each re-validation are on the Licencia Federal and must be stamped at the completion of each physical. This constitutes documentation that the driver is medically qualified. Therefore, if the Licencia Federal is not re-validated every 2 years as specified by Mexican law, the driver’s license is considered invalid.

Question 7: If a motor carriers ends a potential interstate driver to a medical examiner to have both a pre-employment medical examination and a pre-employment controlled substances test performed, how must the medical examiner conduct the medical examination including the certification the driver meets the physical qualifications of §391.41(b)?


The medical examiner must complete the physical examination first without collecting the Part 382 controlled sub stances urine specimen. If the potential driver meets the requirements of Part 391, Subpart E [especially §391.41(b)] and the medical examiner chooses to certify the potential driver as qualified to operate commercial motor vehicles (CMV) in interstate commerce, the medical examiner may prepare the medical examiner’s certificate.

After the medical examiner has completed the medical examiner’s certificate and provided a copy to the potential driver and to the motor carrier who will use the potential driver’s services, the medical examiner may collect the specimen for the 49 CFR Part 382 pre-employment controlled substances test. The motor carrier is held fully responsible for ensuring the potential driver is not used to operate CMVs until the carrier receives a verified negative controlled substances test result from the medical review officer. A Department of Transportation pre-employment controlled substances test is not a medical examination test.

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