Ariz. Admin. Code § R17-5-208 - Commercial Driver License Intrastate Medical Waiver; Intrastate Alternative Physical Qualification Standards for the Loss or Impairment of Limbs
D. The completed
intrastate medical waiver application for a driver applicant not physically
qualified to drive under 49 CFR 391.41(b)(10) shall be accompanied
by:
1. A copy of the medical
examination report and medical examiner's certificate completed pursuant to 49
CFR 391.43 ;
2. A current vision examination
report issued within the last 90 days from the date the report is received by
the Department, completed by an ophthalmologist or optometrist. The report
shall indicate that the applicant has distant visual acuity of at least 20/40
(Snellen), with or without a corrective lens, in one eye, and the applicant's
dominant eye has a visual field of at least 70° peripheral measurement in
one direction and 35° in the opposite direction of the horizontal meridian
and the ability to distinguish the colors of a traffic signal or device showing
standard red, green, and amber, as applicable to the type of medical waiver
being requested;
3. A copy of the driver
applicant's state motor vehicle driving record for the past three years from
each state in which a motor vehicle driver license or permit has been obtained;
and
4. A statement from the employer
that the driver applicant has driven the type of vehicle for which the waiver
is being requested for at least two of the previous five years.
M. An intrastate
medical waiver granted by the Director under subsection (A) to a driver
applicant for monocular vision under subsection (D), shall prohibit the subject
driver from transporting:
1. Passengers for hire;
and
2. Reportable quantities of
hazardous substances, manifested hazardous wastes, and hazardous material
required to be placarded.
P. A driver subject
to an intrastate medical waiver, issued by the Director under subsection (A) to
an applicant for monocular vision under subsection (D), must be physically
examined every year and shall submit the following to the Department's Medical
Review Program, P.O. Box 2100, Mail Drop 818Z, Phoenix, AZ
85001-2100:
1. A vision examination report
issued within the last 90 days from the date the report is received by the
Department, as prescribed under subsection (D)(2); and
2. A current medical examination
report and medical examiner's certificate completed pursuant to 49 CFR 391.43
within the past year.
a. A current medical
waiver evaluation summary, as prescribed under subsection (C)(2);
b. A current vision examination
report, as prescribed under subsection (D)(2), for a driver with monocular
vision;
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
D. The completed intrastate medical waiver application for a driver applicant not physically qualified to drive under 49 CFR 391.41(b)(3) shall be accompanied by:
1. A copy of the medical examination report and medical examiner's certificate completed pursuant to 49 CFR 391.43;
2. An evaluation by a board-certified or board-eligible endocrinologist. A complete endocrinologist evaluation shall consist of:
a. A comprehensive evaluation of the applicant's five-year medical history and current status. The applicant shall provide the examining endocrinologist with a complete medical history as it pertains to the applicant's diabetes or its complications or both, including, the date insulin use began, all hospitalization reports, consultation notes for diagnostic examinations, special studies, follow-up reports, reports of any hypoglycemic insulin reactions within the 12 months prior to the date of application, and other reports as requested by the endocrinologist. The evaluation shall also include a review of:
i. Daily glucose monitoring logs, glycosylated hemoglobin (A1c) indicating a result in the range of 7% to 10%, including lab reference page performed during the last six months unless recently diagnosed;
ii. Insulin dosages and types, diet utilized for control, and all medications taken; and
iii. Examinations to detect any peripheral neuropathy or circulatory insufficiency of the extremities;
b. A statement that the applicant is free from insulin reactions. Insulin reactions include any severe hypoglycemic reaction, which can be a reaction that results in seizure, loss of consciousness, requiring the assistance of another person, or a period of impaired cognitive function that occurs without warning. To be eligible the applicant must not have hypoglycemia unawareness and must have had no more than one documented severe hypoglycemic reaction in the previous 12 months and must have had:
i. No recurrent (two or more) severe hypoglycemic reactions resulting in a loss of consciousness or seizure within the past five years:
ii. No recurrent severe hypoglycemic reactions requiring the assistance of another person within the past five years;
iii. No recurrent severe hypoglycemic reactions resulting in impaired cognitive functions that occurred without warning symptoms within the past five years; and
iv. A period of one year of demonstrated stability following the first period of severe hypoglycemia;
c. A statement prepared and signed by the examining endocrinologist whose status as board-certified or board-eligible is indicated. The signed statement shall include separate declarations indicating the following medical determinations:
i. The endocrinologist is familiar with the applicant's medical history for the past five years through a records review, treating the patient, or consultation with the treating physician;
ii. The applicant is able to safely operate a commercial motor vehicle while using insulin; and
iii. The applicant has been educated in diabetes, including the last education date, and its management and is informed of and understands how to individually manage and monitor the applicant's diabetes mellitus and has demonstrated the ability and willingness to properly monitor and manage the applicant's diabetes and procedures to follow if complications arise;
3. A separate signed vision evaluation report from an ophthalmologist or optometrist indicating that the applicant has been examined and does not have diabetic retinopathy and meets the vision standard of 49 CFR 391.41(b)(10), or has been issued a valid intrastate medical waiver for monocular vision. If the applicant has any evidence of diabetic retinopathy, the applicant must be examined by an ophthalmologist and submit a separate signed statement from the ophthalmologist that the applicant does not have unstable proliferative diabetic retinopathy (i.e. unstable advancing disease of blood vessels in the retina); and
4. A copy of the driver applicant's state motor vehicle driving record for the past three years from each state in which a motor vehicle driver license or permit has been obtained.
Q. A driver subject to an intrastate medical waiver, issued by the
1. Maintain appropriate medical supplies for glucose management while preparing for the operation of a commercial motor vehicle and during its operation. The supplies shall include the following:
a. A digital glucose monitor with computerized memory,
b. Supplies needed to obtain adequate blood samples and to measure blood glucose,
c. Insulin to be used as necessary, and
d. An amount of rapidly absorbable glucose to be used as necessary;
2. Maintain a daily record of actual driving time to correlate with the daily glucose measurements;
3. Monitor and maintain blood glucose levels in the range of 100 to 400 milligrams per deciliter (mg/dl) prior to and while driving.
a. Check glucose before starting to drive and take corrective action if necessary. If glucose is less than 100 mg/dl, take glucose or food and recheck in 30 minutes. Repeat the process until glucose is greater than 100 mg/dl. Do not drive if glucose is less than 100 mg/dl;
b. While driving, stop the vehicle in a safe location and check glucose every two to four hours and take appropriate action to maintain it in the range of 100 to 400 mg/dl;
c. Have food available at all times when driving. If glucose is less than 100 mg/dl, stop driving and eat. Recheck in 30 minutes and repeat procedure until glucose is greater than 100 mg/dl; and
d. If glucose is greater than 400 mg/dl, stop driving until glucose returns to the 100 to 400 mg/dl range. If more than two hours have passed since last insulin injection and eating, take additional insulin. Recheck blood glucose in 30 minutes. Do not resume driving until glucose is less than 400 mg/dl;
4. Participate in a diabetes education program annually;
5. Undergo the following evaluations and examinations and submit to the Department's Medical Review Program, P.O. Box 2100, Mail Drop 818Z, Phoenix, AZ 85001-2100, within 10 days of the date of the evaluation or exam:
a. A quarterly evaluation completed by a board-certified or board-eligible endocrinologist. A quarterly endocrinologist evaluation shall include a review of the driver's daily glucose logs and glucose levels (from the subject driver's required monitoring device), a comparison of monitoring dates to the driving log to ensure that the subject driver is checking glucose levels prior to operating a commercial motor vehicle, a certifying statement indicating that the subject driver is maintaining a glucose level in the range of 100 to 400 mg/dl while driving a commercial motor vehicle, a certifying statement indicating that the subject driver is maintaining a stable insulin regimen and that the subject driver's quarterly A1c result continues to reflect stable control, reports of any severe hypoglycemic episodes, any hypoglycemic-related hospitalization, and any treatment regimen changes since the last hypoglycemic episode;
b. An annual evaluation completed by a board-certified or board-eligible endocrinologist. In addition to the requirements of a quarterly endocrinologist evaluation under subsection (Q)(5)(a), an annual endocrinologist evaluation shall also include a general physical examination, an indication that the driver has continued to participate in a diabetes education program with the last education date provided, a certifying statement indicating that the driver understands how to individually manage and monitor the driver's diabetes mellitus, an indication of the development of, or progression, or both, in diabetes complications (i.e. renal disease, cardiovascular disease, and neurological disease), a list of all medications taken and whether any of the medications may compromise the driver's ability to operate a commercial motor vehicle, the endocrinologist's belief that the driver has demonstrated the ability and willingness to properly manage the driver's diabetes, and a certifying statement indicating that the driver is able to safely operate a commercial motor vehicle while using insulin;
c. An annual vision evaluation report, as prescribed under subsection (D)(3). If there is any evidence of diabetic retinopathy, provide annual documentation by an ophthalmologist that the driver does not have unstable proliferative diabetic retinopathy; and
d. An annual medical examination report and medical examiner's certificate completed pursuant to 49 CFR 391.43. Provide copies of the endocrinologist evaluation and the vision evaluation report to the medical examiner for review; and
6. Report the following information to the Department's Medical Review Program, P.O. Box 2100, Mail Drop 818Z, Phoenix, AZ 85001-2100, within two days of occurrence;
a. All episodes of severe hypoglycemia, significant complications, or inability to manage diabetes; and
b. Any involvement in an accident or any other adverse event in a commercial motor vehicle or personal vehicle, related to an episode of hypoglycemia or hyperglycemia.
b. A current endocrinologist evaluation, as prescribed under subsection (D)(2), and a current vision evaluation report, as prescribed under subsection (D)(3), for a driver who is an insulin-dependent diabetic; or