2010 BC Guide in Determining Fitness to Drive

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11.16 Doctor’s report on commercial driver with diabetes on insulinOffice of the Superintendentof Motor Vehicleswww.pssg.gov.bc.ca/osmvPO BOX 9254 STNPROV GOVTVICTORIA BC V8W 9J2Phone: (250) 387-7747Fax: (250) 952-6888DOCTOR’S REPORT ON COMMERCIAL DRIVER WITH DIABETES ON INSULINNOTE TO THE DOCTOR: on a separate form, the driver has certified that they will: maintain a glycemic log which shows the previous 6 months and records the hours driven and blood glucose checks during that time produce their glycemic log for their doctor’s review when they attend for completion of this form make available records of medical care for the previous 24 months for initial diabetes assessment, and 12 months for re-assessmentPERSONAL HEALTH NUMBER(MUST BE COMPLETED) MSP Fee Code 96222The personal information on this form is collected under the authority of the Motor Vehicle Act, Medicare Protection Act, and the Freedom of Information and Protection of Privacy Act. Theinformation provided will be used to determine your fitness to drive a motor vehicle and allow the physician to bill through the British Columbia Medical Services Plan for the service. Personalinformation is protected from unauthorized use and disclosure in accordance with the Freedom of Information and Protection of Privacy Act and may be disclosed only as provided by that Act.If you have any questions about the collection, use and disclosure of the information collected, contact the Office of the Superintendent of Motor Vehicles at (250) 387-7747.PART A- GENERAL1. Patient’s name 7. Has there been a significant change in insulintherapy, i.e. introduction of insulin, or a change intype of insulin or number of injections? YES NO2. Age when diagnosed Commercial drivers must present a log of bloodglucose measurements performed at least twice dailyfor the previous six months, or since diagnoses ifdiagnosed in the last 6 months, to their examiningphysician.3. How long have you treated this patient for diabetes? 8a. Does the log indicate adequate self-monitoring ofblood glucose? YES NO4. Result of one HbA1c completed within the last three months.Value:5. Does patient have a full understanding of the diabeticcondition and the relationship between insulin dose, diet andexercise? YES NO6. Has impairment by alcohol ever interfered with patient’sability to maintain good control of their diabetes? YES NO8b. Does the data in this patient’s log indicate stableand effective blood glucose control? YES NO9. Does patient take appropriate action based on bloodglucose results? YES NO10. Is this patient’s work schedule compatible withtheir treatment regime? YES NO108
PART B – HYPOGLYCEMIA11a. Has the patient had any hypoglycemic reactions during thepast six months of which you are aware? NO YES11b. If “yes”, indicate the date(s) and type(s) of treatment (i.e. selftreated, treated by another person or by a medical professional12a. Does patient have hypoglycemia unawareness? NO YES12b. If “yes” describe fully13. Does the glycemic log indicate that > 10% of BGlevels
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Ministry of Public Safety and Solic
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AcknowledgmentsResearcherBonnie M.
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Table of Contents (click on any ite
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11.7 Private and commercial drivers
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BACKGROUND ........................
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PART 1:BACKGROUND1
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Appendix 2: Excerpts from the MVA t
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Chapter 2: The Driver Fitness Progr
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for the exercise of discretion by O
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1. SCREENINGA driver disclosesa med
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2.3 Roles and responsibilitiesOSMV
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Medical practitionersMedical practi
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Chapter 3:Driver Fitness Program Pr
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Because of these limitations, OSMV
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Example: the temporary storage of i
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Motor functions (including sensorim
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an individual with poor contrast se
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3.5 Best informationDriver fitness
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Chapter 4: Introduction to the Poli
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3. DETERMINATIONFrom2. AssessmentAn
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Once identified, a DMER is mailed t
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5.3 Screening aging driversDefiniti
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5.5 Transient impairmentsDefinition
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Chapter 6: Assessment Policies and
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6.2 Assessments will only be reques
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6.4 Requesting specialist assessmen
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Policy6.5.1 If a case manager or ad
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Persistent and episodic impairments
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further assessment. Drivers who sco
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6.9.4 A case manager or adjudicator
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ASSESSMENT PROCEDURESCase manager o
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A driver fitness determination is a
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Policy rationaleBecause individuals
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Page 79 and 80: has the judgment and willingness to
Page 81 and 82: Policy7.11.1 If a case manager or a
Page 83 and 84: (e) the medical condition results i
Page 85 and 86: 7.12 Communicating a decisionPolicy
Page 87 and 88: 7.13 Determination proceduresThe fo
Page 89 and 90: During the reconsideration, the adj
Page 91 and 92: 8.3 Reconsideration proceduresThe f
Page 93 and 94: Chapter 9:Introduction to the Medic
Page 95 and 96: 9.4 Medical condition chapter templ
Page 97 and 98: Private and commercial drivers who
Page 99 and 100: Chapter 11: Diabetes - Hypoglycemia
Page 101 and 102: PercentFigure 1 - Prevalence of Dia
Page 103 and 104: neuropathy, nephropathy, cardiovasc
Page 105 and 106: 11.7 Private and commercial drivers
Page 107 and 108: 11.8 Private drivers with diabetes
Page 109 and 110: 11.9 Commercial drivers with diabet
Page 111 and 112: RestrictionsRe-assessmentguidelines
Page 113 and 114: Policy rationaleSevere hypoglycemia
Page 115 and 116: 11.12 Private drivers who have pers
Page 117 and 118: 11.13 Commercial drivers who have a
Page 119 and 120: 11.14 Commercial drivers who have a
Page 121: 11.15 Commercial drivers who have p
Page 125 and 126: Produce my glycemic log for my doct
Page 127 and 128: Deep-vein thrombosisDeep-vein throm
Page 129 and 130: Aneurysms less than 5 cm in diamete
Page 131 and 132: GUIDELINES12.6 Private and commerci
Page 133 and 134: 12.7 Private drivers who have an an
Page 135 and 136: 12.9 Commercial drivers who have an
Page 137 and 138: Chapter 13: Musculoskeletal Conditi
Page 139 and 140: ConditionType of drivingimpairment
Page 143 and 144: ConditionsRestrictionsRe-assessment
Page 145 and 146: 14.3 Chronic renal disease and adve
Page 149 and 150: 14.8 Private drivers with end-stage
Page 151 and 152: 14.10 Private and commercial driver
Page 153 and 154: Level ofImpairmentMildlyImpairedMod
Page 157 and 158: 15.8 Commercial drivers with modera
Page 159 and 160: 15.10 Commercial drivers with sever
Page 161 and 162: Policy rationaleDrivers who require
Page 163 and 164: Chapter 16: Vestibular DisordersBAC
Page 165 and 166: One study identified that 32.5% of
Page 167 and 168: ConditionType ofdrivingimpairmentan
Page 169 and 170: Re-assessmentguidelinesPolicy ratio
Page 171 and 172: 16.8 Private and commercial drivers
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16.10 Private and commercial driver
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Individuals who have undergone valv
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Episodic impairmentThe potential ep
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GUIDELINES17.6 Policy rationaleThes
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17.9 Commercial drivers with corona
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17.11 Private drivers who have had
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17.15 Private drivers who have vent
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17.19 Private drivers who have sust
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17.21 Commercial drivers who have s
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17.27 Private drivers with atrioven
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17.28 Commercial drivers with atrio
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17.29 Private drivers with permanen
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17.31 Private drivers who have decl
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17.33 Private drivers where ICD the
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17.35 Commercial drivers who have d
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17.37 Commercial drivers with inher
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17.39 Commercial drivers with medic
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17.41 Private drivers with surgical
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17.43 Private drivers with mitral v
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17.45 Private drivers with congesti
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17.46 Commercial drivers with conge
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17.47 Private drivers with left ven
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17.49 Private drivers with a heart
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17.51 Private drivers with hypertro
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17.53 SyncopeSee the guidelines in
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Stable coronary syndromes - waiting
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Chapter 18: Hearing LossBACKGROUND1
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GUIDELINES18.6 Private drivers with
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equirement for commercial drivers i
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PLEASE COMPLETE THE FOLLOWING: YES
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this manual. Axis IV addresses exte
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Negative symptoms are characterized
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Schizophrenia (Axis I)Schizophrenia
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19.4 Effect of psychiatric disorder
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Suicidal ideationSuicidal ideation
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GUIDELINES19.6 Private and commerci
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Chapter 20: Cerebrovascular Disease
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Cerebrovascular accidentCVAs are th
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ConditionType of drivingimpairment
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Re-assessmentguidelinesPolicy ratio
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20.9 Private drivers who have had s
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20.10 Commercial drivers who have h
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Visual field impairment refers to a
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Right homonymous hemianopiaBinasal
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An example of the effects of diabet
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Retinitis pigmentosaRetinitis pigme
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GlaucomaApproximately 67 million pe
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indicates that wait times of 6 mont
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Although telescopic spectacles, hem
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Policy rationaleretinopathy dependi
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Policy rationaleIndividuals with be
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Re-assessmentguidelines cont’dPol
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Re-assessmentguidelines cont’dPol
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21.13 Commercial drivers with a los
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21.17 Visual field impairmentsTypes
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21.18 Examination of visual functio
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VISUAL FIELD TEST (VFT)For drivers
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To the Driver:Under section 29 of t
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Please note:Goldman, Esterman and H
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Cardiac syncopeCardiac syncope refe
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22.7 Private drivers who have had a
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22.9 Private drivers with recurrent
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22.11 Commercial drivers who have h
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22.13 Commercial drivers with recur
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Chapter 23: Seizures and EpilepsyBA
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abnormal numbnesstingling and a cra
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23.10 Private drivers with single u
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23.12 Private drivers with epilepsy
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23.18 Commercial drivers with epile
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Level of disabilityor worsening of
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Parkinson’s diseaseThere is a sma
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ConditionsRestrictionsRe-assessment
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25.2 Prevalence and incidence of tr
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Chapter 26: Intracranial TumoursBAC
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Some examples of compensatory mecha
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i. aphasia (language disturbance)ii
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27.2 Prevalence and incidence of co
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27.4 Effect of cognitive impairment
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Chapter 28: Sleep DisordersBACKGROU
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An immediate reduction in daytime s
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28.5 CompensationIndividuals with s
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OSMV determinationguidelines cont
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ConditionsRestrictionsRe-assessment
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Policy rationaleThe general approac
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Chapter 29: Prescription and Over-T
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Examples of newer antihistamines in
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Stimulants (for ADHD)Examples of st
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AntiepilepticsIn general, individua
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Sedating EffectLowModerateHighTCAsd
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dizziness, andblurred or double vis
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30.2 Effect of general debility and
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Appendix 1: Glossary of TermsCommer
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Medical assessmentis any kind of as
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Transient impairmentmeans a tempora
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must cause to be issued to the appl
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(ii) cancel the person's driver's l
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Appendix 3: Aging DriversAbout agin
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Percentadults. The survey also foun
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Appendix 4: Licence ClassesThe tabl
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Appendix 5: Drafting and Approval P
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drivers, this means that BC commerc
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2010 BC Guide in Determining Fitness to Drive

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