Federal Register - July 7, 2021
Versión en texto ¿Qué es?Dateas es un sitio independiente no afiliado a entidades gubernamentales. La fuente de los documentos PDF aquí publicados es la entidad gubernamental indicada en cada uno de ellos. Las versiones en texto son transcripciones no oficiales que realizamos para facilitar el acceso y la búsqueda de información, pero pueden contener errores o no estar completas.
Fuente: Federal Register
35646
Federal Register / Vol. 86, No. 127 / Wednesday, July 7, 2021 / Rules and Regulations
1634
I
l.aSt llane: - - - - - - - - - - FirstName: - - - - - - - OOS: _ _ _ _ _ _ ExamDate: _ _ _ _ _ _ _
j
TESTING
Pro:teln
Systolic:
!JI@
Sittill9
S:ecohd reai:ling optional
Urinalysis is requlnad.
Numetical difg$
must be recqrded.
othertesing 1f illdlca,ed
Protein, blood, orsuffelri/1 tlie urine may be art iH!/ieatiOI.fQrliJrthertest/ng to rule rot anyundeliyinv medicafpOo/em.
Vililoti
flearlng
Standi:Ird1sailast<20/40acuity /5nellen.ineacheyewlth orwithootcorrectiM
0
i;tleast7QP/ielifofvisitsn ilJ /:rbr/Z.IJntame,iclian measu/ed.ini.,a.th;eye. The user;,
SiandardiMilsttirstperceive whlspereitvo/ceat nottessthan SfeetCIR averqge /rearing loss ofless,han or equalt041d8, ilJbettetecrr fw/tl! orwitnrut hearillg a.id,
r;orrectiveknses should be notedon the Medical /?xaminei:s. Certificate.
Acutty-
Uhcomected
Corrected
Horizontal Freid ofVision
Chec!
Right Eye:
20/_ _
10_ _
light Eye:: _ _ d8Qti!es
Wf!ispetl.utReiiults
haft Ey
201_.-
20/_ _
LeffEye: _ _ degrees
SothEyesc:
lQ/ _ _
20/_ _
0
Neither
Right Ear eftEar
lleco .dist11nc<1 inJe frg,:n dri atwhkh a for<;eq whil,pered voice can firstbeheattl
Yes 11,10
OR
Appllcantcan recognl:ze and distlrfgulsh amongtraffkcontro!
signals and devlce,sshowing red, green, and amber cqlor
00
Mona ular v:fslpn
00
:Aui!lolbetriTestlleslllts Right Eat:
SOOHz iOOOHz iOOOHz
S:OOH
Referred loophthallt!Ol
00
Average right: _ _ _ _ __
Average li!ft: _ _ _ _ __
00
eftl;at;
lllQO:Hz
.2000 Hz
PHYSICAL EXAMINATION
ihepresencenfa certaincondition:maynotnecessarily disqualify a driver,particularlyiftheconditlon is<:ontrolled adequat;;ly, is not likelytti worh, ilr ;sreadily amenablEto treatmen.t,Even if a <:onc!1tion:d 11ot c1 isqulify a dri.v-er, the Med ital Exa 1111 ner m;,y consider dafei:t1n9 the cttiver temp<1rarily. Also.thediivershould be aclyised totallethe necessary steps to correct the condition as soon as,possil:!le,partlaularly if neglecting the QnditlOI cou Id resu It .in a 1110,e serious ill nes.s that might affect drNin-g.
:Check the.body systemsfqrabnormalities.
Normal Al:inoritial
Body swtei!I
0
0
1.General 2,Skin
80
3.Eyes 4.l;?IS
S:.Mouth/throat 6. tardlovas<:ular
0
0
0
Nc,:rrnal Af:ihormI
0
10.. Batl
12, Nurologlcal system Including reflexes tl.Gait 14. Vi!SCU Tar system
0
0
0
i!.Alldomen Qc. Genifo-urlnarysystem inducllng hernias:
0
0
0
0
0
0
7.Lungs/chest 0
0
Discuss any abnormal answers in detailin thespace below and indicate whether it wou!daffet:t the drivers ability to operate a CM,.
0
0
0
0
0
0
0
Enterapplicableiteir number befofe:each comment.
Attach additional sheets ifnecessary
VerDate Sep<11>2014
15:58 Jul 06, 2021
Jkt 253001
PO 00000
Frm 00052
Fmt 4700
Sfmt 4725
E:FRFM07JYR1.SGM
07JYR1
ER07JY21.079
khammond on DSKJM1Z7X2PROD with RULES
Page3
