23.3.507 MEDICAL STATEMENT REQUIRED FOR TYPE 2 ENDORSEMENT
(1) An applicant for a type 2 endorsement must complete a medical statement on a form supplied by the department unless he/she presents a current medical certificate. The statement includes:
(a) the applicant's full name as it appears on the Montana driver's license or application;
(b) the applicant's date of birth;
(c) the applicant's social security number;
(d) whether or not the applicant has a current federal waiver or exemption, and, if so, for what condition;
(e) whether or not the applicant has a loss of a foot, a leg, a hand, or an arm;
(f) whether or not the applicant has an impairment of any limb or extremity;
(g) whether or not the applicant has an established medical history or clinical diagnosis of diabetes mellitus, currently requiring insulin for control, and, if so, the date of the last episode or treatment;
(h) whether or not the applicant has a current clinical diagnosis of heart disease or cardiovascular disease of a variety known to be accompanied by fainting, dizziness, shortness of breath, collapse, or congestive cardiac failure, and, if so, the name of the condition and the date of the last episode or treatment;
(i) whether or not the applicant has an established medical history or clinical diagnosis of a respiratory disease;
(j) whether or not the applicant has an established medical history or clinical diagnosis of rheumatic, arthritic, orthopedic, muscular, or vascular disease which could interfere with his ability to perform the normal tasks associated with the operation of a motor vehicle;
(k) whether or not the applicant has an established medical history or clinical diagnosis of epilepsy or any other condition which is likely to cause loss of consciousness or any loss of muscular or motor control, and if so, the name of the condition and the date of the last episode;
(l) whether or not the applicant has a mental, nervous, organic, or functional disease or psychiatric disorder likely to interfere with ability to drive a motor vehicle safely;
(m) whether or not the applicant wears corrective lenses for correction of distant vision;
(n) whether or not the applicant uses amphetamines, narcotics, or any habit forming drugs;
(o) whether or not the applicant has a current clinical diagnosis of alcoholism;
(p) the signature of the applicant swearing or affirming that the items in the medical statement are true and correct to the best of his/her knowledge and belief.
(2) If the applicant has any condition set forth in items (f) through (o) , the applicant may be required to submit a statement from his physician which includes, but is not limited to:
(a) the current clinical diagnosis of the condition in question;
(b) the date(s) , within the last 5 years, of any episode of the conditions which resulted in a loss of consciousness or control, or which prevented the driver from operating a motor vehicle;
(c) the medication(s) , if any, currently prescribed for the condition; and
(i) known side effects of each medication(s) which could tend to affect the driver's state of consciousness, vision, or muscular control;
(ii) whether or not the side effects noted have been exhibited or reported by the driver;
(iii) a statement indicating whether the condition is chronic or temporary and, if chronic, whether controlled or advancing.
(3) If it is determined from the information contained in the physician's statement that the driver is subject to loss of consciousness, motor control, mental alertness, or skeletomuscular freedom of movement to a degree which affects his ability to operate a motor vehicle, either from his condition or from medication, the application must be denied.
History: Sec: 61-5-112, 61-5-117, 61-5-125 MCA; IMP, Sec. 61-5-102, 61-5-104 to 61-5-107, 61-5-110 to 61-5-113, 61-5-201, 61-5-206, 61-5-207 MCA; NEW, 1988 MAR p. 62, Eff. 1/15/88; AMD, 1989 MAR p. 486, Eff. 4/28/89.