Utah residents are individually responsible for their health when driving.  All applicants for licenses will complete a health questionnaire to show their functional ability to drive.  If there is a significant health problem, they will take their medical and/or vision form to a health care professional who will assess the category for the condition indicated.  Licensed ophthalmologists and optometrists may only complete the vision form.  Individuals may not determine a safety assessment level for themselves.  The health care professional will be expected to discuss the applicant’s health as it relates to driving and to make special recommendations in unusual circumstances.  Based upon a completed Functional Ability Evaluation form (FAE)/Certificate of Vision (CVE), the Driver License Division may issue a license with or without limitations as outlined in these Guidelines and Standards approved by the Utah Driver License Medical Advisory Board (MAB).  Health care professionals (HCP) have the opportunity to increase highway safety by carefully applying these guidelines and standards and counseling with their patients about driving.

DRIVERS RESPONSIBILITIES
The Utah State Legislature reaffirmed these responsibilities related to physical, mental, or emotional impairments of drivers: 

1. Drivers are responsible to refrain from driving if “they have, or develop, or suspect that they have developed a physical, mental, or emotional impairment which may affect driving safety.”
2. Drivers in such a situation are expected to seek competent medical evaluation and advice about the significance of the impairment as it relates to driving safety. 
3. Drivers are responsible for reporting to the Driver License Division if “they have or develop, or suspect a physical, mental, or emotional impairment which may affect driving safety.”

HEALTH CARE PROFESSIONALS' RESPONSIBILITIES
The same legislation applies to Utah health care professionals in these ways: 

1. Health care professionals may be requested by their patients to make reports to the Driver License Division about impairments which may affect driving safety, but the final responsibility for issuing a driver license lies with the Driver License Division. 
2. In addition to making accurate reports when authorized by their patients, health care professionals are expected to counsel their patients about how their condition affects safe driving.  For example, if patients are put on medications which may cause changes in alertness or coordination, their health care professional should advise them not to drive at least until a dosage is established which will not affect safe driving; or, if visual acuity drops, they should similarly be advised, at least until corrective action has been taken to improve their vision.  The following quotation recognizes this important function:

 “Health care professionals who care for patients with physical, mental, or emotional impairments that may affect their driving safety, whether defined by published guidelines and standards or not, are responsible for making available to their patients without reservation their recommendations and appropriate information related to driving safety and responsibilities."

The guidelines and standards which follow will be a useful reference in such counseling.

IMMUNITY IN REPORTING POTENTIAL RISKS
The legislature eliminated a major obstacle for health care professionals with its provision that: 

“A health care professional or other person who becomes aware of a physical, mental, or emotional impairment that appears to be an imminent threat to driving safety and reports this information to the Division in good faith has immunity from any damages claimed as a result of making the report.”

UTAH DRIVER LICENSE MEDICAL ADVISORY BOARD
A Driver License Medical Advisory Board was created to advise the Director of the Driver License Division and to recommend written guidelines and standards for determining the physical, mental, and emotional capabilities appropriate to various types of driving.  Members of the board have been appointed by the Commissioner of the Department of Public Safety to represent a variety of special areas.

If patients are uncertain about the interpretations of these guidelines and standards or have special circumstances, they may request a review by a panel of board members. All of the actions of the Director and Board are subject to judicial review.  The Board operates under the authority of Utah Code Annotated 53-3-303.

The Board has developed the following functional ability safety assessment guidelines and standards in an effort to minimize the conflict between the individual’s desire to drive and the community’s desire for safety.  Through education, medical assistance, and cooperative efforts, an ideal balance may be reached.  Principles followed by the Board in developing the guidelines and standards are detailed in this guide.

PRINCIPLES USED IN DEVELOPING GUIDELINES AND STANDARDS FOR DEFINING DRIVING CAPABILITY
In cooperation with the Director of the Utah Driver License Division, the Medical Advisory Board has followed these ten principles in developing these guidelines and standards:

1. Guidelines and standards should be the least restrictive possible, consistent with public safety.
2. Functional ability to operate a vehicle safely, rather than impairments, should receive emphasis.
3. Some impairments will permit driving safely under appropriate restrictions as to speed, area, time of day, and use of compensating devices, etc. (see Table 2 below)
4. Fairness should prevail in these ways: 
   1. Medically impaired drivers should not be required to meet guidelines and standards of expected safety in excess of those expected of unimpaired drivers; and 
   2. Drivers with different kinds of impairments, but with similar estimated increases in driving risk, should have as nearly the same restrictions as possible.
5. A system for assessing all aspects of a person’s health which may adversely affect driving, either intermittently or continuously, will be used by applicants for a driver license.
6. Health care professionals should not be expected to function as policemen, prosecutors, or judges in the process of driver evaluation, but as individuals skilled in diagnosis and accurate reporting of functional ability, as well as teachers and advisers to their patients.
7. Since the ultimate responsibility for safety lies with all drivers, they should be involved in self-evaluation, with medical evaluations being used to confirm or change its accuracy.
8. Every opportunity should be used to educate all drivers and applicants about the effects of physical and emotional health problems, use of drugs, etc. on their ability to drive safely.
9. If anything related to licensing can be simplified safely, this should be done.
10. Health care professionals are invited to help put into effect these principles of safety and fairness and of increasing driver awareness of health in relation to driving safety.

FUNCTIONAL ABILITY/SAFETY ASSESSMENT LEVEL CATEGORIES
Functional ability to operate a vehicle safely may be affected by a wide range of physical, mental, or emotional impairments.  To simplify reporting and to make possible a comparison of relative risks and limitations, the Medical Advisory Board has adopted physical, emotional, and behavioral functional ability safety assessment levels including categories, with multiple levels under each category listed below.  Vehicle operation history should be included as a significant part of a complete medical history.

• CATEGORY A: Diabetes Mellitus and Other Metabolic Conditions
• CATEGORY B: Cardiovascular Conditions
• CATEGORY C: Pulmonary Conditions
• CATEGORY D: Neurologic Conditions
• CATEGORY E: Seizures and other Episodic Conditions
• CATEGORY F: Learning, Memory, and Communication Disorders
• CATEGORY G: Mental Health
• CATEGORY H: Alcohol and Other Drugs
• CATEGORY I: Visual Disorders
• CATEGORY J: Musculoskeletal Abnormality or Chronic Debility
• CATEGORY K: Alertness or Sleep Disorders

USE OF THE FUNCTIONAL ABILITY/SAFETY ASSESSMENT LEVEL
When requested by the staff of the Driver License Division, applicants must report information regarding their physical, mental, and emotional health.  This may be in the form of a short screening questionnaire or a more extensive assessment outline.  On completion of this and other requirements, a license may be issued immediately, or the applicant may be requested to take a Functional Ability Evaluation/Certificate of Vision form to their own health care professional for confirmation of the safety assessment or change of the assessment as the health care professional believes is indicated. 

These guidelines and standards contain eleven sections, one for each functional ability category.  Each begins with a short narrative summary of basic concepts, definitions, and working ground rules.  Each summary is followed by a table showing: 

1. Eight to ten safety assessment levels based upon history, laboratory findings, or other information. 
2. Safety assessment levels which must be confirmed (or modified) by a health care professional.
3. Intervals between health care professional confirmation of the safety assessment level.
4. License class and restrictions (see Tables 1-3 below) will generally be used by personnel of the Driver License Division to issue licenses consistent with the functional ability safety assessment level.

In almost all cases, a health care professional caring for a patient will have adequate information to complete the requested medical form(s).  However, if there is a significant problem affecting driving which is outside their area of capability, ordinary medical practices should apply.  For example, a condition requiring a specialized diagnosis or opinion would suggest a referral to an appropriate specialist before completing the assessment.  On the other hand, a specialist who has seen a patient only for a limited or technical service may: 

1. Decline to complete the full assessment (especially if there are multiple medical conditions); 
2. Suggest patients see their personal health care professional; and 
3. Provide pertinent information to help in completion of the assessment. 

In some circumstances where the limited condition is the only one affecting driving, a health care professional may complete the form based upon history, without extensive examinations or tests, if they are satisfied with the patient’s reliability. 

Where a driver applicant indicates no significant impairment other than visual, they may complete the Certificate of Visual Examination form.  The Certificate of Visual Examination form may be completed by licensed ophthalmologists and optometrists as well.  However, licensed ophthalmologists and optometrists may only complete the vision form.

Reports should be based upon reasonably current information.  In case of doubt, medical common sense should prevail.  Since no special tests are required by the guidelines and standards beyond those needed by a healthcare professional for adequate diagnosis or treatment, no additional expense should result except in unusual circumstances or in cases where individuals may wish to submit additional information, such as a review by a recognized specialist in specific medical conditions, in preparation for review by a medical panel.

Reports of safety assessment levels must be signed by a health care professional licensed to practice, although they may rely upon portions of examinations done under their supervision.  A health care professional may not complete a medical or vision form if the medical or vision form is for themselves. 

The Medical Advisory Board conducted a six-month pilot program on medical information submitted by nurse practitioners and physician assistants.  On March 28, 2002, the Medical Board made the decision that Nurse Practitioners and Physician Assistants could continue to evaluate, complete, and sign the Functional Ability Medical Evaluation Report at all levels provided: 

1. The Nurse Practitioner or Physician Assistant is adequately trained and qualified in the category they are evaluating; and
2. If the Nurse Practitioner or Physician Assistant lacks information or training in a specific area, they will defer assessing the driver.