[Federal Register: August 5, 1998 (Volume 63, Number 150)] [Proposed Rules] [Page 41769-41781] From the Federal Register Online via GPO Access [wais.access.gpo.gov] [DOCID:fr05au98-37] ----------------------------------------------------------------------- DEPARTMENT OF TRANSPORTATION Federal Highway Administration 49 CFR Part 391 [FHWA Docket No. FHWA-98-3542] RIN 2125-AC63 Physical Qualification of Drivers; Medical Examination; Certificate AGENCY: Federal Highway Administration (FHWA), DOT. ACTION: Notice of proposed rulemaking (NPRM); request for comments. ----------------------------------------------------------------------- SUMMARY: The FHWA is seeking comments on a proposal to amend its regulation governing the examination to determine the physical condition of drivers. The FHWA takes this action in response to numerous requests from medical examiners to update and simplify the medical examination form that is currently used. This proposed action is intended to reduce the incidence of errors on such forms and to provide more uniform medical examinations of commercial motor vehicle (CMV) drivers under the Federal Motor Carrier Safety Regulations (FMCSRs). The current Federal physical qualification standards tested by medical examiners and recorded on the form would not be revised in this rulemaking. The FHWA is seeking comments on the proposed form. DATES: Written comments addressing this rule must be received on or before November 3, 1998. ADDRESSES: Your signed, written comments must refer to the docket number appearing at the top of this document and you must submit the comments to the Docket Clerk, U.S. DOT Dockets, Room PL-401, 400 Seventh Street, SW., Washington, D.C. 20590-0001. All comments received will be available for examination at the above address between 10 a.m. and 5 p.m., e.t., Monday through Friday, except Federal holidays. Those desiring notification of receipt of comments must include a self- addressed, stamped envelope or postcard. FOR FURTHER INFORMATION CONTACT: Mrs. Sandra Zywokarte, (202) 366-1790, Office of Motor Carrier Standards, for information regarding the rulemaking, or Ms. Judith A. Rutledge, (202) 366-0834, Motor Carrier Law Division, Office of the Chief Counsel, for information regarding legal issues. Federal Highway Administration, Department of Transportation, 400 Seventh Street, SW., Washington, D.C. 20590. Office hours are from 7:45 a.m. to 4:15 p.m., e.t., Monday through Friday, except Federal holidays. SUPPLEMENTARY INFORMATION: Electronic Access Internet users can access all comments received by the U.S. DOT Dockets, Room PL-401, by using the universal resource locator (URL): http://dms.dot.gov. It is available 24 hours each day, 365 days each year. Please follow the instructions online for more information and help. An electronic copy of this document may be downloaded using a modem and suitable communications software from the Federal Register Electronic Bulletin Board Service at (202)512-1661. Internet users may reach the Federal Register's home page at: http://www.nara.gov/nara/ fedreg and the Government Printing Office's database at: http:// www.access.gpo.gov/su__docs. Background The authority to require medical certification of CMV driver qualification was originally granted to the Interstate Commerce Commission (ICC) in the Motor Carrier Act of 1935. The authority was transferred to the DOT in 1966 and is currently codified at 49 U.S.C. 31502(b). The importance of physical qualification of commercial drivers was recognized in 1939 when the first regulatory medical standard was established by the ICC. Those [[Page 41770]] regulations, published June 7, 1939, required a driver to possess the following minimum qualifications: Good physical and mental health; good eyesight; adequate hearing; no addiction to narcotic drugs; and no excessive use of alcoholic beverages or liquors. The first change to this standard was initiated in 1952 and went into effect on January 1, 1954. The Certificate of Physical Evaluation required under the 1954 rule was slightly more specific than the 1939 regulation, and also required a physical examination form and a doctor's certificate. A second revision made in 1964 amended the standard to allow limb-amputee and limb-impaired drivers, who were otherwise eligible, to become medically qualified through a waiver program. On April 22, 1970, (35 FR 6458) in light of discussions with the FHWA's medical advisors, the existing physical qualification requirements were substantially tightened by including guidelines for evaluation of persons in high-risk medical categories. This rule also provided that the examining physician be given full information about the responsibilities of and the exacting demands made on commercial drivers. There have been no major changes since then. Current Medical Examination Form The current form was adopted by the DOT in 1970, recodified in 49 CFR part 391, and has undergone no changes since that time. The physical qualification regulations for drivers in interstate commerce are found at 49 CFR 391.41. Section 391.43 contains instructions to medical examiners for performing physical examinations and recording their findings. The FHWA has received numerous verbal and written requests from physicians and other medical providers who perform physical examinations of CMV drivers engaged in interstate commerce to make changes to the medical form currently used under Sec. 391.43(e). Medical practitioners have indicated that the format, layout and content of the current form are outdated, difficult to use and contain irrelevancies. For example, the health history section of the form asks about a history of fits, syphilis and gonorrhea, and nervous stomach. Such inquiries reflect outdated terminology, are vague, or are not relative to a driver's ability to operate a CMV safely. Others have suggested that the form is not adaptable to current trends in documentation such as electronic documentation. Given these comments, the FHWA has decided to initiate this proposed rulemaking action. Over the past two decades there have been substantial changes in medical technology and the technology, operating practices and economics of the motor carrier industry. These changes have affected the lifestyles of and, therefore, the physical and mental demands placed on CMV drivers. The FHWA agrees that the current form is outdated and its continued use problematic. Methods and Considerations for Developing a Revised Medical Examination Form The FHWA contracted with the Association for the Advancement of Automotive Medicine (AAAM) to review and evaluate the current form, and to help develop a revised form. In order to assure that the revised form would reflect the most current medical concepts and be responsive to the needs of the groups using the forms such as the medical community and the trucking industry, the AAAM convened a working group to review the draft form. This group included two occupational health physicians, a motor carrier and Federal and State government representatives. A second draft of the form was then submitted for additional review by a correspondence review group made up of medical providers, State agency representatives, motor carriers, FHWA field staff, and other interested groups. The form revision process was defined and limited by several norms. The underlying physical qualification standards tested by medical providers and recorded on the form would not be revised in this rulemaking. In addition, the instructions for performing and recording physical examinations found in 49 CFR 391.43 would be revised only to the extent necessary to ensure that instructions to medical examiners are understandable and consistent with the information provided on the proposed medical examination form and guidance materials established by the FHWA for medical examiners. Proposed Medical Examination Form The proposed form, modeled on physical examination forms in use today, has been organized to gain simplicity and efficiency, to reflect current medical terminology and examination components and to be a self-contained document; that is, the proposed form will, to the extent possible, include all relevant information necessary to conduct the physical examination and certification. The FHWA believes its proposed revision to the form will enhance the accuracy and efficiency of the commercial driver physical qualification process. Consistent with accepted practices regarding the order of the examination, the first section of the proposed form would be completed by the driver. This section requests information on the driver's health history, seeking ``yes'' or ``no'' answers to a variety of medical condition questions. Any ``yes'' response would require further clarification by the driver. Once the form is completed, the driver would be required to sign it, affirming that all the information contained therein is accurate and complete. An additional statement indicates that inaccurate, false, or missing information may invalidate both the examination and any Medical Examiner's Certificate issued thereon. A result of such invalidation could include revocation of the driver's commercial license by the issuing State. The FHWA believes that the proposed addition of a driver certification requirement would discourage drivers from omitting or falsifying medical information and thereby would ensure the accuracy and completeness of the medical form and strengthen the overall certification process. The second section of the proposed form covers the physical examination and tests performed by the medical examiner. The medical examiner is provided with information on both the relevant Federal physical qualification standards and the tests required to measure compliance with those standards. The Federal standards and guidelines for evaluation of a driver's vision, hearing, and blood pressure are included in this section of the proposed form, thereby reducing the potential for errors by the medical examiner. Missing or inconsistent information on the examination form has been a problem according to anecdotal information provided by the motor carrier industry and other users of the form, and according to information obtained from six pilot demonstration programs to verify the six States' ability to merge the medical process with the CDL licensing process. 1 --------------------------------------------------------------------------- \1\ The pilot projects were completed in January 1995, and a final report (see docket, FHWA-97-2210) was submitted to the FHWA. On July 23, 1996, the FHWA announced (61 FR 38133) the first meeting of a negotiated rulemaking advisory committee under the Federal Advisory Committee Act and the Negotiated Rulemaking Act to consider the relevant issues and attempt to reach a consensus in developing regulations governing the proposed merger of the State-administered commercial driver's license procedures and the Federal driver physical qualification requirements. For complete information on the six pilot projects and the negotiated rulemaking advisory committee proceedings, see 59 FR 36338 (July 15,1994) and 61 FR 18713 (April 29, 1996). --------------------------------------------------------------------------- [[Page 41771]] Unlike the current physical examination form, the proposed form clearly indicates when numerical readings must be recorded. Moreover, since the physical qualification regulations do not indicate acceptable laboratory values for the presence of protein, blood or sugar in the urine, the proposed form places the medical examiner on notice that the presence of these substances in the urine may be an indication for further testing to rule out an underlying medical condition that may be disqualifying. Space is also provided for optional tests, such as an electrocardiogram (ECG), an echocardiogram, an exercise stress test (EST) or a chest x-ray. In addition, a complete physical examination must be performed for each driver. Although the ECG and EST are considered optional, the FHWA is proposing specific recommendations for a baseline ECG at age 40, then every six years until age 55, and then every two years. In this proposal, the FHWA also recommends that an EST be given to asymptomatic individuals who are 45 years old or older and who either exhibit two or more cardiac risk factors or have a history of ischemic heart disease. These recommendations were developed during a 2-day conference on cardiac disorders and commercial drivers at the American College of Cardiology in Bethesda, Maryland in 1986. The conference was convened to assist the FHWA in developing a systematic and scientific basis for updating the cardiac standards for commercial drivers. The final report published in 1988 provided very specific recommendations for qualifying drivers with cardiovascular conditions and for screening drivers for cardiac risk factors. This cardiac conference guidance has been extensively peer reviewed and is being updated as necessary. A copy of this cardiac conference guidance is contained in the docket for public inspection. A full page of the proposed form is devoted to instruction and recordation of the medical examiner's findings. The medical certificate is also provided, and must be completed by the medical examiner if he or she finds that the driver meets all the Federal physical qualification requirements. The third section of the proposed form not only sets forth the Federal physical qualification standards found at 49 CFR 391.41, but also contains more detailed information for the medical examiner regarding the driver's role and the types of duties he or she may face as a result of his or her employment. The FHWA believes that this information is valuable to the medical examiner in making a determination of physical qualification, and that such information may not have been provided to medical examiners in the past because it was not included on the current medical examination form. This section also contains the FHWA's guidelines to help medical examiners assess a driver's physical qualification. These guidelines are strictly advisory and were established by the FHWA after consultation with physicians, States, and industry representatives. In addition to the revisions to 49 CFR 391.43 proposed in this NPRM, the FHWA is making technical corrections to paragraphs (d) and (g) of that section. The FHWA's primary concern is to enhance safety on the Nation's highways, not to unnecessarily limit the employment opportunities of individuals with physical impairments. To the fullest extent possible, consistent with its safety mandate and regulations, the FHWA is interested in promoting individual determinations of medical qualification to operate a CMV. The intent of this proposal is to facilitate medical providers' efforts to establish, and document in a clear and understandable way, the physical qualification of a driver to operate a CMV. Consequently, the FHWA requests comments from individuals, medical providers, motor carriers, and all other interested parties on the proposed medical examination form. The information should include, but need not be limited to, information on how to improve the proposed examination form and instructions for performing and recording physical examinations. Rulemaking Analyses and Notices All comments received before the close of business on the comment closing date indicated above will be considered and will be available for examination in the docket room at the above address. Comments received after the comment closing date will be filed in the docket and will be considered to the extent practicable, but the FHWA may issue a final rule at any time after the close of the comment period. In addition to the late comments, the FHWA will also continue to file in the docket relevant information that becomes available after the comment closing date, and interested persons should continue to examine the docket for new material. Executive Order 12866 (Regulatory Planning and Review) and DOT Regulatory Policies and Procedures The FHWA has determined that the proposed action, if implemented, would not be a significant regulatory action under Executive Order 12866 or significant under the regulatory policies and procedures of the DOT. It is anticipated that the economic impact of this proposed rule would be minimal because the use of existing printed supplies of the forms addressed in this action will be allowed until the forms are depleted, or until 12 months after the date of publication of this rulemaking in the Federal Register, whichever occurs first. Allowing the use of existing forms would avert substantial monetary loss by motor carriers, medical providers, and vendors of forms that might otherwise result from this rulemaking. Moreover, the proposed action would facilitate regulatory uniformity and result in easier compliance with and enforcement of the driver qualification requirements of the FMCSRs. The proposed form would, to the extent possible, include all relevant information necessary to establish and record the physical qualification of a driver to operate a CMV. As a result, the FHWA believes that this rulemaking would have a positive economic impact. That is, time and cost burdens on truck and bus companies would not increase and, indeed, such burdens on medical examiners could actually decrease. Therefore, a full regulatory evaluation is not required. Regulatory Flexibility Act In compliance with the Regulatory Flexibility Act, 5 U.S.C. 601- 612, the FHWA is evaluating the effects of this proposal on small entities. The FHWA believes that this proposed action, if implemented, would not have a significant economic impact on a substantial number of small entities or the nation's economy because it would allow individual small carriers, medical providers and vendors of the form to use the forms they now have on hand until those supplies have been depleted, or until 12 months after the date of publication of this rulemaking in the Federal Register. To the extent that the proposed revised form would facilitate compliance with driver qualification requirements, the projected positive economic impact is not expected to be sufficiently significant to warrant a full regulatory evaluation. The FHWA intends to further evaluate the economic consequences of this proposal on small entities, however, in light of the [[Page 41772]] comments received in response to this notice of proposed rulemaking. Unfunded Mandates Reform Act of 1995 The FHWA will analyze any proposed rule to determine whether it would result in the expenditure by State, local, and tribal governments, in the aggregate, or by the private sector, of $100 million or more in any one year, as required by the Unfunded Mandates Reform Act of 1995 (2 U.S.C. 1532). Executive Order 12612 (Federalism Assessment) This proposed rulemaking, if promulgated, would amend Part 391 of the FMCSRs (Title 49, Code of Federal Regulations) pertaining to the physical qualification and examination of drivers. This proposal has been analyzed in accordance with the principles and criteria contained in Executive Order 12612. Nothing in this proposal would preempt any State law or regulation. This proposal would not limit the policy making discretion of the States. Therefore, the FHWA has determined that this proposal does not have sufficient federalism implications to warrant the preparation of a separate Federalism Assessment. Executive Order 12372 (Intergovernmental Review) Catalog of Federal Domestic Assistance Program Number 20.217, Motor Carrier Safety. The regulations implementing Executive Order 12372 regarding intergovernmental consultation on Federal programs and activities do not apply to this program. National Environmental Policy Act The agency has analyzed this action for the purposes of the National Environmental Policy Act of 1969, as amended (42 U.S.C. 4321 et seq.), and has determined that this action will not have any effect on the quality of the environment. Paperwork Reduction Act The information collection requirements that would be imposed as a result of this rulemaking are being submitted to the OMB for approval in accordance with the Paperwork Reduction Act of 1995, 44 U.S.C. 3501- 3520. This rulemaking proposes a revision of a form used to collect medical information about drivers of commercial motor vehicles (CMVs). Title: Medical Qualifications Requirements. Affected Public: Approximately 400,000 motor carriers and 500,000 medical examiners. Abstract: Medical examiners are required to perform examinations of CMV drivers who operate in interstate commerce. The results must be recorded substantially in accordance with the instructions and the form found at 49 CFR 391.43. Medical examiners are also required to fill out a medical certificate upon completing an examination. The certificate affirms that the driver is medically qualified to drive a CMV in interstate commerce. Under 49 CFR 391.51 and 398.3, motor carriers are required to retain the medical examiner's certificate in the driver's qualification file for 3 years. Need: To ensure that only physically qualified CMV drivers operate in interstate commerce. Requested Time Period of Approval: The information collection for this item, OMB Control Number, 2125-0080, was last approved by OMB on September 2, 1997. It is valid through September 30, 2000. Estimated Annual Burden: Based on an estimate of 5,500,000 interstate CMV drivers, the annual time burden upon medical examiners and motor carriers for examinations and recordkeeping would be approximately 412,500 hours. This is a decrease of 46,605 hours from the burden under the previous form. Comments are invited on any aspect of the proposed collection of information, including but not limited to: (1) The necessity and utility of the information collection for the proper performance of the functions of the FHWA; (2) the accuracy of the estimated burden; (3) ways to enhance the quality, utility, and clarity of the collected information; and (4) ways to minimize the collection burden without reducing the quality of the collected information. Regulation Identification Number A regulation identification number (RIN) is assigned to each regulatory action listed in the Unified Agenda of Federal Regulations. The Regulatory Information Service Center publishes the Unified Agenda in April and October of each year. The RIN contained in the heading of this document can be used to cross reference this action with the Unified Agenda. List of Subjects in 49 CFR Part 391 Driver qualifications--physical examinations, Highway safety, Motor carriers, Reporting and recordkeeping requirements, Safety, Transportation. Issued: July 29, 1998. Kenneth R. Wykle, Federal Highway Administrator. In consideration of the foregoing, the FHWA proposes to amend title 49, CFR, chapter III, part 391 as follows: PART 391--QUALIFICATIONS OF DRIVERS [REVISED] 1. The authority citation for part 391 continues to read as follows: Authority: 49 U.S.C. 504, 31133, 31136, and 31502; and 49 CFR 1.48. 2. Section 391.43 is amended in paragraphs (d), (f), (g), and (h), to read as follows: Sec. 391.43 Medical examination; certificate of physical qualification. * * * * * (d) Any driver authorized to operate a commercial motor vehicle within an exempt intracity zone pursuant to Sec. 391.62 of this part shall furnish the examining medical examiner with a copy of the medical findings that led to the issuance of the first certificate of medical examination which allowed the driver to operate a commercial motor vehicle wholly within an exempt intracity zone. (e) * * * (f) The medical examination shall be performed, and its results shall be recorded, substantially in accordance with the following instructions and examination form. Existing forms may be used until current printed supplies are depleted or until (Insert date 12 months after the date of publication in the Federal Register), whichever occurs first. INSTRUCTIONS FOR PERFORMING AND RECORDING PHYSICAL EXAMINATIONS The medical examiner must be familiar with 49 CFR 391.41, Physical qualifications for drivers, and should review these instructions before performing the physical examination. Answer each question ``yes'' or ``no'' and record numerical readings where indicated on the physical examination form. The medical examiner must be aware of the rigorous physical, mental, and emotional demands placed on the driver of a commercial motor vehicle. In the interest of public safety, the medical examiner is required to certify that the driver does not have any physical, mental, or organic condition that might affect the driver's ability to operate a commercial motor vehicle safely. General information. The purpose of this history and physical examination is to detect the presence of physical, mental, or organic conditions of such a character and extent as to affect the driver's ability to operate a commercial motor vehicle safely. The examination should be conducted carefully and should at least include all of the information requested in the following form. History of certain conditions may be cause for rejection, indicate the need for further testing, and/or require evaluation by a specialist. Conditions may be recorded which do not, because of their character or degree, indicate that certification of physical fitness should be denied. However, these conditions should be discussed with the driver and he/she should be advised to take the necessary [[Page 41773]] steps to insure correction, particularly of those conditions which, if neglected, might affect the driver's ability to drive safely. General appearance and development. Note marked overweight. Note any postural defect, perceptible limp, tremor, or other conditions that might be caused by alcoholism, thyroid intoxication or other illnesses. Head-eyes. When other than the Snellen chart is used, the results of such test must be expressed in values comparable to the standard Snellen test. If the driver wears corrective lenses for driving, these should be worn while driver's visual acuity is being tested. If appropriate, indicate the driver's need to wear corrective lenses to meet the vision standard on the Medical Examiner's Certificate by checking the box, ``Qualified only when wearing corrective lenses.'' In recording distance vision use 20 feet as normal. Report all vision as a fraction with 20 as the numerator and the smallest type read at 20 feet as the denominator. Monocular drivers are not qualified to operate commercial motor vehicles in interstate commerce. The use of contact lenses should be noted on the form and there should be sufficient evidence of good tolerance of and adaptation to their use. Ears. Note evidence of any ear disease, symptoms of aural vertigo, or Meuniere's Syndrome. When recording hearing, record distance from patient at which a forced whispered voice can first be heard. For the whispered voice test, the individual should be stationed at least 5 feet from the examiner with the ear being tested turned toward the examiner. The other ear is covered. Using the breath which remains after a normal expiration, the examiner whispers words or random numbers such as 66, 18, 23, etc. The examiner should not use only sibilants (s-sounding test materials). The opposite ear should be tested in the same manner. If the individual fails the whispered voice test, the audiometric test should be administered. For the audiometric test, record decibel loss at 500 Hz, 1,000 Hz, and 2,000 Hz. Average the decibel loss at 500 Hz, 1,000 Hz and 2,000 Hz and record as described on the form. If the individual fails the audiometric test and the whispered voice test has not been administered, the whispered voice test should be performed to determine if the standard applicable to that test can be met. Throat. Note any irremediable deformities likely to interfere with breathing or swallowing. Heart. Note murmurs and arrhythmias, and any history of an enlarged heart, congestive heart failure, or cardiovascular disease that is accompanied by syncope, dyspnea, or collapse. Indicate onset date, diagnosis, medication, and any current limitation. An electrocardiogram (ECG), exercise stress test (EST) and other tests are required when findings so indicate. It is recommended that a baseline ECG be done at age 40, then every 6 years until age 55, then every 2 years thereafter, and an EST be done at age 45 if the individual manifests one or more cardiac risk factors or has a history of ischemic heart disease. Blood pressure(BP). If a driver has hypertension and/or is being medicated for hypertension, he or she should be recertified more frequently. An individual diagnosed with mild hypertension (initial BP is greater than 160/90 but below 181/105) should be certified for one 3-month period and should be recertified on an annual basis thereafter if his or her BP is reduced. An individual diagnosed with moderate to severe hypertension (initial BP is greater than 180/104) should not be certified until the BP has been reduced to the mild range (below 181/105). At that time, a 3-month certification can be issued. Once the driver has reduced his or her BP to below 161/91, he or she should be recertified every 6 months thereafter. Lungs. Note abnormal chest wall expansion, respiratory rate, breath sounds including wheezes or alveolar rales, impaired respiratory function, dyspnea, or cyanosis. Abnormal finds on physical exam may require further testing such as pulmonary tests and/or x-ray of chest. Abdomen and Viscera. Note enlarged liver, enlarged spleen, abnormal masses, bruits, hernia, and significant abdominal wall muscle weakness and tenderness. If the diagnosis suggests that the condition might interfere with the control and safe operation of a commercial motor vehicle, further testing and evaluation is required. Genital-urinary and rectal examination. A urinalysis is required. Protein, blood or sugar in the urine may be an indication for further testing to rule out any underlying medical problems. Note hernias or severe hemorrhoids. A condition causing discomfort should be evaluated to determine the extent to which the condition might interfere with the control and safe operation of a commercial motor vehicle. Neurological. Note impaired equilibrium, coordination, or speech pattern; paresthesia; asymmetric deep tendon reflexes; sensory or positional abnormalities; abnormal patellar and Babinski's reflexes; ataxia. Abnormal neurological responses may be an indication for further testing to rule out an underlying medical condition. Any neurological condition should be evaluated for the nature and severity of the condition, the degree of limitation present, the likelihood of progressive limitation, and the potential for sudden incapacitation. In instances where the medical examiner has determined that more frequent monitoring of a condition is appropriate, a certificate for a shorter period should be issued. Spine, musculoskeletal. Previous surgery, deformities, limitation of motion, and tenderness should be noted. Findings may indicate additional testing and evaluation should be conducted. Extremities. Carefully examine upper and lower extremities and note any loss or impairment of leg, foot, toe, arm, hand, or finger. Note any deformities, atrophy, paralysis, partial paralysis, clubbing, edema, or hypotonia. If a hand or finger deformity exists, determine whether prehension and power grasp are sufficient to enable the driver to maintain steering wheel grip and to control other vehicle equipment during routine and emergency driving operations. If a foot or leg deformity exists, determine whether sufficient mobility and strength exist to enable the driver to operate pedals properly. In the case of any loss or impairment to an extremity which may interfere with the driver's ability to operate a commercial motor vehicle safely, the medical examiner should state on the medical certificate ``medically unqualified unless accompanied by a limb waiver.'' The driver must then apply to the Regional Director of Motor Carriers, in the region in which the driver has legal residence, for a limb waiver under Sec. 391.49. Laboratory and Other Testing. Other test(s) may be indicated based upon the medical history or findings of the physical examination. Diabetes. If insulin is necessary to control a diabetic driver's condition, the driver is not qualified to operate a commercial motor vehicle in interstate commerce. If mild diabetes is present and it is controlled by use of an oral hypoglycemic drug and/or diet and exercise, it should not be considered disqualifying. However, the driver must remain under adequate medical supervision. Upon completion of the examination, the medical examiner must date and sign the form, provide his/her full name, office address and telephone number. The completed medical examination form shall be retained on file at the office of the medical examiner. BILLING CODE 4910-22-P [[Page 41774]] [GRAPHIC] [TIFF OMITTED] TP05AU98.001 [[Page 41775]] [GRAPHIC] [TIFF OMITTED] TP05AU98.002 [[Page 41776]] [GRAPHIC] [TIFF OMITTED] TP05AU98.003 [[Page 41777]] [GRAPHIC] [TIFF OMITTED] TP05AU98.004 [[Page 41778]] [GRAPHIC] [TIFF OMITTED] TP05AU98.005 [[Page 41779]] [GRAPHIC] [TIFF OMITTED] TP05AU98.006 [[Page 41780]] [GRAPHIC] [TIFF OMITTED] TP05AU98.007 [[Page 41781]] (g) If the medical examiner finds that the person he/she examined is physically qualified to drive a commercial motor vehicle in accordance with Sec. 391.41(b), the medical examiner shall complete a certificate in the form prescribed in paragraph (h) of this section and furnish one copy to the person who was examined and one copy to the motor carrier that employs him/her. (h) The medical examiner's certificate shall be substantially in accordance with the following form. Existing forms may be used until current printed supplies are depleted or until (insert date 12 months after the date of publication in the Federal Register), whichever occurs first. [GRAPHIC] [TIFF OMITTED] TP05AU98.008 [FR Doc. 98-20919 Filed 8-4-98; 8:45 am] BILLING CODE 4910-22-C