Application For Intrastate Medical Waivers - Mass Rmv printable pdf download

Medical Affairs Branch

Registry of Motor Vehicles

P.O. Box 55889

Boston, MA 02205

857-368-8020

APPLICATION FOR INTRASTATE MEDICAL WAIVERS

TO OPERATE CLASS A, B, OR C COMMERCIAL MOTOR VEHICLES

Medical Waivers for the operation of commercial motor vehicles INTRASTATE ONLY (within the borders of Massachusetts

only) will be issued in accordance with the provisions of 540 CMR 14.04 (1)(d).

The Registrar may issue an intrastate waiver for the following conditions ONLY:

1. A VISION IMPAIRMENT if:

the individual has a combined horizontal peripheral field of vision of not less than 120 degrees, provided the individual also has

a distant visual acuity of at least 20/40 (Snellen) in either eye, with or without corrective lenses, and the ability to distinguish the

colors red, green, and amber;

2. A DIABETIC CONDITION if:

the individual submits a written statement from his or her physician (defined on reverse side of this application) which: provides

specific reasons why the individual is not at risk or is no longer at risk of suffering hypoglycemic spells or episodes; and

recommends a specific date for the Registry to re-evaluate the individual s ability to operate a commercial motor vehicle safely;

3. A CARDIOVASCULAR CONDITION if:

the individual does not have an implanted cardiac defibrillator for a “sudden death” event and does not have Class III or Class

IV heart disease according to the American Heart Association functional guidelines for classifying heart disease; and

4. A LOSS OR IMPAIRMENT OF LIMB so long as such loss or impairment of limb is not likely to interfere with the safe

operation of a commercial motor vehicle.

5. A HEARING IMPAIRMENT if:

the certifying physician states the condition will not interfere with the safe operation of a commercial vehicle. For vehicles with

air brakes, an applicant must be able to hear the air compressor cutting out and detect an actual air leak in the braking system- a

safety precaution in case the gauges have malfunctioned. Therefore, a profoundly deaf person would not pass this portion of the

test and would be restricted to a commercial vehicle without airbrakes.

Individuals with these specified conditions may obtain an intrastate waiver provided that the condition will not interfere with the

safe operation of a commercial motor vehicle, as certified by their physician.

Please note: Applicants who need to pass the Commercial Driver Road Test may request a reasonable accommodation limited

to additional time to perform the pre-trip inspection and maneuvers. The request for a reasonable accommodation must be from

a physician, written on the physician’s letterhead, describing the medical need of additional time. ONLY accommodations for

additional time will be granted. All applicants must pass all aspects of the Commercial Driver Road Examination.

Intrastate waivers shall NOT be applicable to SCHOOL BUS operator certificates.

The following documentation MUST be submitted with this completed application, certified by your medical

professional, to the Medical Affairs Branch:

1. A copy of the results of a recent DOT medical examination performed pursuant to 49 CFR 391.43,

upon which the examining physician has indicated that you are only qualified to operate a

commercial motor vehicle with an intrastate medical waiver; and

2. A letter from your employer acknowledging that you have a medical waiver and that you drive

commercially as a requirement of employment within the borders of Massachusetts only.

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Application For Intrastate Medical Waivers - Mass Rmv