sdj7811 Posted June 13, 2018 Share Posted June 13, 2018 I'm curious how everybody handles temporary clearance for DOT exams. I will give a temporary clearance (usually 1 or 3 months) if I am waiting on additional information (specialist clearance, a1c results, etc.) Then, once I get the clearance I need I will sign new cards with an updated expiration date without seeing the patient again (calculating the expiration date from the date I saw the patient initially). There are some in my organization that are now saying I need to do another complete physical once I receive the additional information. I have tried to contact FMCSA for an answer, and they keep contradicting themselves and I can't get a definitive answer. How do others do it? Link to comment Share on other sites More sharing options...
Mcshald Posted June 13, 2018 Share Posted June 13, 2018 New rules in past year or so requires new exam when card expires whether 1 week, one month, or 3 months. Previously extensions were allowed without new exam. Link to comment Share on other sites More sharing options...
sdj7811 Posted June 13, 2018 Author Share Posted June 13, 2018 Thanks for the info. Any idea where I can access the source documents to present to my colleagues? There is some disagreement... Link to comment Share on other sites More sharing options...
Mcshald Posted June 13, 2018 Share Posted June 13, 2018 This is the only info I can access right now. It was a big deal when it changed and my employer required us all to read and acknowledge the changes then. I don’t have that info at my fingertips now as it was quite a while ago. It is from the NCRME forum Link to comment Share on other sites More sharing options...
sdj7811 Posted June 13, 2018 Author Share Posted June 13, 2018 Thanks for the info, apparently my organization missed the boat when this changed. If anybody can help point me in the direction of official documentation regarding this I would be grateful. Link to comment Share on other sites More sharing options...
Guest UVAPAC Posted June 13, 2018 Share Posted June 13, 2018 There really is supposed to be no such thing as "a temporary card." You either 1) Pass 2) Fail 3) Pending additional information. In the case that someone comes in without proper documentation regarding certain medical conditions you can "pend" them if you feel they are safe to drive given your current information. If their current card is not expired they may legally continue to drive. If they don't have a current valid card, they are unable to drive until they provide you the information you need. What if their HA1C is 15 and you are clearing them to drive? What if they haven't seen their cardiologist in 10 years and they have a myocardial infarction while driving a bus full of children? What if they have sleep apnea, haven't worn their machine in 5 years, and fall asleep behind the wheel? With the verbiage of the current guidelines, you would certainly be sued, possibly lose your medical license, and live with the guilt of your decision for the rest of your life. Link to comment Share on other sites More sharing options...
sdj7811 Posted June 13, 2018 Author Share Posted June 13, 2018 UVAPAC, Thanks for the reply. I wasn't clear in my initial post. In all of you "what if" situations I would absolutely not give a card. I'm not handing out clearance willy nilly! In your diabetes example, the only way I would consider "temporary clearance" for a diabetic would be if we had a good a1c on file within the last 12 months or so, no glucosuria, and a normal fingerstick. I would just want an updated a1c before I signed off for another year. In your MI example. If they had a cardiac history or significant risk factors I would consider a "temporary" clearance if I had cardiology clearance from last year, a stable EKG, etc. Maybe I just need an updated echo. I have been using what I considered to be common sense. But apparently I'm not doing it correctly, which is why I asked the original question and am looking for the official guidelines. I think I haven't been using the "pending additional information" category correctly. If they do have a current clearance and I give them a pending status, I can then sign off when I get the additional information without doing another complete exam, correct? Link to comment Share on other sites More sharing options...
Guest UVAPAC Posted June 13, 2018 Share Posted June 13, 2018 sdj, Understood, think it is more reasonable in the instances you described above. I try my best to use the pending additional information for several reasons: 1) 45 days is generally adequate time to get any additional information/documentation required. 2) It avoids the patient having to have an entirely new physical conducted, and charging them for a second exam in a short period of time. 3) It takes a lot of risk/liability out of your hands. As you mentioned if they have an Echo on file from 1 year ago documenting "mild aortic stenosis" and over the past year they have progressed to severe, and have syncope while driving you would ultimately be responsible. If you "pend" the patient it basically states based on the previous years examination you are not disqualifying them, but not qualifying them this year until more is known. I always encourage patients to come back 2-3 weeks prior to their cards expiration date so if there is an issue we can "pend" and obtain additional information without it being an issue. Link to comment Share on other sites More sharing options...
sdj7811 Posted June 13, 2018 Author Share Posted June 13, 2018 Thanks UVAPAC. That makes a lot of sense. I'm going to make that change effective today. Thanks for the info Link to comment Share on other sites More sharing options...
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