Pursuant to the Maryland Vehicle Law and these regulations, the Administrator shall obtain information regarding the physical and mental condition of an individual who seeks to drive on the highways of this State. Drivers of Commercial Motor Vehicles. Drivers of commercial vehicles shall meet the physical qualifications in §B(2)—(4) of this regulation. Interstate Operations. Interstate drivers of commercial motor vehicles shall meet the physical qualifications of the Federal Motor Carrier Safety Regulations contained in 49 CFR 390—392, which is incorporated by reference. Intrastate Operations. Intrastate drivers of commercial motor vehicles shall meet the physical qualifications of COMAR 11.21.01 which incorporates by reference, subject to certain amendments and exemptions, the Federal Motor Carrier Safety Regulations contained in 49 CFR 390—392. School Vehicle Operations. Drivers of school vehicles shall meet the physical qualifications of COMAR 11.19.05 and 11.21.01 which incorporate by reference, subject to certain amendments and exemptions, the Federal Motor Carrier Safety Regulations contained in 49 CFR 390—392. Under Transportation Article, §16-119, Annotated Code of Maryland, any physician and any other person authorized to diagnose, detect, or treat the following disorders, may report to the Administration and to the subject of the report, in writing, the full name, date of birth, and address of each individual 15 years old or older who has a disorder that: Is characterized by lapses of consciousness; or Results in a corrected visual acuity that fails to comply with the vision requirements of Transportation Article, Title 16, Subtitle 1, Annotated Code of Maryland. Lapses of Consciousness. A lapse of consciousness is defined as failure to be oriented to time, place, person, situation. Examples of lapses of consciousness or unconsciousness are: Automatism; Confusion; Stupor; Delirium; and Coma. Among the conditions that can cause an individual to have a significant risk of lapses of consciousness are: Epilepsy; Narcolepsy; Cardiovascular disease; Cerebrovascular disease; Alcoholism; Drug addiction; and Severe hypoglycemia. Individuals who have a significant risk of lapses of consciousness due to any condition or disease may be reported pursuant to Transportation Article, §16-119, Annotated Code of Maryland. A judgment of significant risk shall be based on: Knowledge of an individual's past history of lapses of consciousness and the present state of the individual's health; How well the individual's disorder is controlled; or How much the individual's condition has improved. Individuals who have any disorder which prevents them from having a corrected minimum visual acuity of 20/40 in each eye and a field of vision of at least 140 degrees may be reported pursuant to Transportation Article, §16-119, Annotated Code of Maryland. A licensee or an applicant for a driver’s license shall notify the Administration if the licensee or applicant is diagnosed as having any of the following: Diabetes that has caused a low blood sugar episode requiring assistance from another person in the last 6 months; Epilepsy; Seizure; A heart condition that has caused a loss of consciousness in the past 6 months; Stroke; A condition that causes you to have dizzy spells, fainting, or blackouts; Sleep apnea or narcolepsy; A history of traumatic brain injury (TBI); A condition that causes weakness, shaking, or numbness in the arms, hands, legs, or feet that may affect your ability to drive; A hand, arm, foot, or leg, that is absent, amputated, or has a loss of function that may affect your ability to drive; An eye problem which prevents a corrected minimum visual acuity of 20/70 in at least one eye or binocular field of vision of at least 110 degrees; Alcohol use problem; Drug use problem; A mental health condition that may affect your ability to drive; Schizophrenia; or Dementia. The Administrator may include with the application for, or renewal of, a Maryland driver's license, an information insert containing the list of reportable physical or mental conditions indicated in §A of this regulation, and remind the individual of the individual's responsibility to indicate on the application if the individual has been treated for a reportable physical or mental condition. Upon application for, or renewal of, a driver's license, the applicant shall answer any question submitted by the Administration pertaining to any disorders affecting the applicant's ability to drive. Upon diagnosis of a medical condition listed in §A of this regulation, a licensee shall notify the Administration. Upon receipt of an application for a driver’s license, or renewal of a driver’s license, on which an individual has indicated that the individual has been treated for any of the listed disorders, or when an individual is referred to the Medical Advisory Board by the Administrator for any other reason, the Administration shall follow the procedures set forth below: The Administration may require the individual to obtain from the individual's physician a report indicating the onset of the condition, the physician's diagnosis and prognosis and the medication being prescribed. The individual shall forward the physician's report to the Medical Advisory Board of the Administration. When the Medical Advisory Board receives the physician's report, a determination shall be made as to whether the physical or mental condition indicated in the report is of the type that might impair the individual's ability to operate a motor vehicle. If a determination is made that the condition might do so, the individual may be scheduled to appear before a physician of the Medical Advisory Board for an interview. At this interview the individual will be given the opportunity to present additional medical information on the individual's own behalf and will be required to answer any questions asked by the physician conducting the interview. If an individual is asked to appear for an interview before a physician of the Medical Advisory Board, the individual shall be: Notified in writing of the physical or mental condition being evaluated by the Board; and Notified of the name of the physician who is conducting the interview and the physician's medical specialty. The Medical Advisory Board shall follow the guidelines set forth in §§B—J of this regulation when making a recommendation to the Administration. Cardiovascular Impairments. Contraindications. Contraindications for the safe operation of a motor vehicle under any circumstance may include, but are not limited to: Unstable angina; Recovering from myocardial infarction of less than 4 weeks duration; Recovering from open heart surgery within the past 6 weeks; Recovering from heart transplantation surgery, 6 weeks after discharge; Placement of a left ventricular assist device discharge; Severe, uncontrolled congestive heart failure; Severe, uncontrolled hypertension; Cardiac infections not responding to appropriate therapy; Unoperated critical aortic stenosis or subaortic stenosis; Unoperated aneurysms of the aorta or cerebrovascular system; Loss of or impaired consciousness due to, but not limited to, uncontrolled arrhythmias, pacemaker failures, and cardiomyopathy; A symptom within 6 months after discharge of an automatic implantable cardioverter defibrillator (AICD); Any of the following arrhythmias: Alternating left or right bundle branch block (LBBB or RBBB) second degree AV; Mobitz II (distal AV block); or Acquired third degree AV block; and Survivors of sudden death with automatic implantable cardioverter defibrillator (AICD) devices still discharging at intervals of less than 3 months. An individual who has a condition listed in §B(1) of this regulation may be considered for a license by submitting evidence acceptable to the Medical Advisory Board that the condition: Has been modified, either medically or surgically; and Is well controlled without recurrence or relapse. Cases shall be evaluated on an individual basis by the Medical Advisory Board in doubtful or unclear circumstances. Additional or periodic follow-up reports may be required by the Administration for review by the Medical Advisory Board. Diseases of the Endocrine System. Diabetes Mellitus. An individual with diabetes mellitus requiring insulin may be reviewed by the Medical Advisory Board. Hypoglycemia. An individual who suffers from recurrent severe uncontrolled attacks of hypoglycemia may not operate any type of motor vehicle and may not be considered for any class license. Diseases of the Neuromusculoskeletal System. An individual who has a significant musculoskeletal impairment shall be evaluated by the Medical Advisory Board before being licensed initially or before having the individual's license to operate a motor vehicle renewed. Diseases of the Nervous System. Cerebral Hemorrhage, Infarction, or Traumatic Brain Injury (TBI). An individual who has had a cerebral hemorrhage, infarction, or TBI that has resulted in a marked change in personality, alertness, ability to make decisions, loss of coordination, motor power, visual acuity, visual field, or any other neurological deficit shall be reviewed by the Medical Advisory Board. Seizures. The driver's license or driving privilege of an individual with seizures may be suspended or refused for a period of 90 days or more from the date of the last seizure. An individual whose driver's license or driving privilege has been suspended or refused under §E(2)(a) of this regulation may request that the period of suspension or refusal be withdrawn or modified by submitting evidence of favorable modifiers acceptable to the Medical Advisory Board. The Medical Advisory Board shall consider favorable and unfavorable modifiers under §E(2)(e) and (f) of this regulation in determining whether to recommend that the suspension or refusal period be withdrawn or modified to more or less than 90 days. The withdrawal or reduction or increase of the suspension or refusal period shall be based upon the recommendation of the Medical Advisory Board. Favorable modifiers include: Seizures during medically directed medication changes; Simple partial seizures that do not interfere with consciousness or motor control; Seizures with consistent and prolonged auras; Established pattern of pure nocturnal seizures; and Favorable driving record. Unfavorable modifiers include: Noncompliance with medication or medical visits; Alcohol or drug abuse in the past 3 months; Unfavorable driving record; Structural brain lesion; Placement of a vagal nerve stimulator to control seizure activity; and Seizure control requiring three or more medications. Periodic follow-up reports may be required by the Administration for review by the Medical Advisory Board. At the conclusion of the suspension or refusal period, the Medical Advisory Board shall reevaluate the individual and recommend appropriate action. The procedures for the restoration of the driver's license following a period of ineligibility are set forth in COMAR 11.17.04. Narcolepsy. An individual under treatment for this condition may not be considered for any class of license until the individual has been free of symptoms for at least 6 months and is experiencing no side effects from medications. The individual shall be cleared by the Medical Advisory Board. Psychiatric Disorders. Psychopathic Personality. An individual who has a disregard for accepted social values, who has a history of impulsive or irresponsible behavior, and who is frequently rebellious to authority or openly aggressive, with consequent loss of caution and good judgment, may not be considered for any class of license. Personality, Character, and Psychotic Disorders. An individual with severe symptoms of personality, character, or psychotic disorders shall be evaluated by the Medical Advisory Board for a license on the basis of alertness, social behavior, psychomotor retardation, and side effects from drug therapy. Substance Use Disorders. In this section, a certified substance abuse treatment program means a program which has been certified by the Alcohol and Drug Abuse Administration of the Maryland Department of Health. A severe substance use disorder is characterized by physical or psychological dependence, or both, on certain psychoactive chemical substances, as shown through the continued use of these psychoactive chemical substances despite harmful or adverse circumstances. A mild or moderate substance use disorder involves harmful or hazardous use of substances which can be both licit, for example medication, and illicit. These substances include, but are not limited to: Central nervous system depressants such as alcohol, tranquilizers, and opiates and their derivatives; Hallucinogens; Stimulants; and Volatile solvents. Before being considered for a license, an individual who has been involved in two alcohol-related or other substance-related driving incidents during the past 5 years, or three or more alcohol-related or other substance-related driving incidents in a lifetime, is required to submit satisfactory evidence to the Administration of: Complete abstinence from substance use for 6 months or as determined by the Administration on a case-by-case basis; Enrollment in, or completion of a substance abuse treatment program for at least 90 days or longer as determined by the Administration on a case-by-case basis; and Participation in a self-help group for a period of time as determined by the Administration on a case-by-case basis. As a condition for approval, the Administration may impose certain restrictions, limitations, or other requirements determined to be appropriate to ensure an individual's safe driving of a motor vehicle, including enrollment in an ignition interlock program. Regardless of the number of incidents, if as the result of investigation, or assessment, an applicant is determined to have alcoholism or a chemical addiction that has not been addressed, the Administration may require evidence of at least 90 days of satisfactory completion of a certified substance abuse treatment program. An individual who is a paraplegic, quadriplegic, or has the loss of one or more limbs may be required by the Medical Advisory Board to submit to driver's reexamination to determine the individual's ability to safely operate a motor vehicle. Traumatic Brain Injury. After the review of medical reports submitted by a physician, a rehabilitation facility, or an occupational therapist, the Medical Advisory Board or Administration may require an examination or reexamination consisting of law, vision and driving tests. If the Medical Advisory Board recommends suspension or refusal of a driving privilege, and the recommendation is followed by the Administration, a letter shall be sent by first class mail to the individual, stating: When the suspension or refusal becomes effective; The reasons for the suspension or refusal; When licensure will be reconsidered; That an administrative hearing may be requested in writing; That the effective date of the suspension will be stayed until the administrative hearing is conducted if the individual has a valid license, except in emergency situations; and That the individual may be represented by an attorney at the administrative hearing. The provisions set forth in Regulation .05 of this chapter also apply when the Administration, based upon a recommendation of the Medical Advisory Board, continues a suspension or refusal. If an individual requests an administrative hearing after a decision of the Administration based upon a recommendation of the Medical Advisory Board, the Administration, except as provided in §B of this regulation, shall inform the individual of all records and documents considered by the Medical Advisory Board, including their source and the dates of examinations or treatments from which they were prepared, and the individual shall have the right to inspect and copy the records and documents during hours designated by the Administration. Records and documents designated confidential by their source may not be disclosed, nor their contents revealed, except by court order. If the physical or mental condition of an individual indicates there is a likelihood of substantial and immediate danger and harm to the individual or others if the individual's license is continued pending evaluation by the Medical Advisory Board, then the individual's driving privileges shall be suspended pursuant to the provisions of Transportation Article, §16-206, Annotated Code of Maryland. The physical or mental condition may come to the attention of the Administration when: A physician's certificate is received by the Medical Advisory Board; The individual is referred to the Medical Advisory Board for any reason; The Administration receives information that a licensee has violated a restriction, limitation, or other requirement imposed as a prerequisite for issuance or reinstatement of a license; or When the Administration becomes aware of a serious medical condition in any other manner. The individual shall be notified in writing of the suspension either: By personal delivery to the individual; or By mail to the individual at the last address of record with the Administration. The notice under §B of this regulation shall: Describe the mental or physical conditions supporting the emergency suspension; and Inform the individual of the right to inspect and copy all medical records and other documents considered in the emergency suspension, except records and documents designated confidential by their source, under Regulation .07 of this chapter. In addition to using the records of the Medical Advisory Board to determine the qualifications of an individual to drive, the Administration may use information contained within those records for the purpose of driver safety research. Records of the Medical Advisory Board are confidential, except as provided under Transportation Article, §§16-118 and 16-119, Annotated Code of Maryland, in which information may be used for the purpose of driver safety research, provided that personal information relating to the identity of the individual is not disclosed. An individual's personal information that may not be disclosed includes: Name; Address; Telephone number or numbers; Email address; Driver's license number; Social Security number; and Any other information that may be used to specifically identify an individual. The Administration may cooperate with other research entities on driver safety research under the conditions and restrictions set forth in this regulation. An outside organization requesting to collaborate with the Administration on driver safety research shall: Submit a written explanation of the purpose of the research to include: The scope of the proposed research; The type of information being requested; How this information would be utilized; Contact information for the organization; and Other information as necessary to render a decision on the collaboration; Complete an Institutional Review Board approved study protocol, and attach the Institutional Review Board's approval before requesting information contained in Medical Advisory Board records; Execute the Privacy Protection Policy provided by the Administration; and Comply with the current research proposal requirements provided by the Administration. The Administration shall review the information obtained under §E of this regulation and, in consultation with the Medical Advisory Board, render a decision on the use of its records for the specific purpose of the proposed research. The Administration may impose conditions on the use of its records by any outside organization and may deny access to information at any time. The Administration may require funding from the outside organization to cover the cost of converting information from the records of the Medical Advisory Board into a usable format. An outside organization shall provide the Administration with a copy of any research reports or articles, before final completion or publication, which utilizes or references the information provided by the Administration or the Medical Advisory Board. The Administration may establish additional guidelines for the submission of information requests. Transportation Article, §§12-104(b), 16-106, 16-110, 16-118, 16-119, 16-206, and 16-208, Annotated Code of Maryland Effective date: February 4, 1976 (3:3 Md. R. 152) Regulations .01, .02, .04, .06, and .08 amended effective September 22, 1978 (5:19 Md. R. 1446) Chapter revised effective January 23, 1981 (8:2 Md. R. 114) Regulations .01, .02, .04, and .05 amended effective June 21, 1982 (9:12 Md. R. 1224) Regulation .01 amended, Regulation .02 repealed, and new Regulations .02 and .02-1 adopted as an emergency provision effective October 27, 1986 (13:24 Md. R. 2555); adopted permanently effective April 6, 1987 (14:7 Md. R. 832) Regulation .01 amended effective January 15, 1996 (23:1 Md. R. 29) Regulation .02 amended effective March 28, 2016 (43:6 Md. R. 409) Regulation .02A, B amended effective May 2, 2011 (38:9 Md. R. 553) Regulation .02-1 amended effective March 28, 2016 (43:6 Md. R. 409) Regulation .02-1A amended effective November 10, 2003 (30:22 Md. R. 1583); April 7, 2008 (35:7 Md. R. 750); May 2, 2011 (38:9 Md. R. 553) Regulation .02-1B amended effective September 16, 1991 (18:18 Md. R. 2007); April 7, 2008 (35:7 Md. R. 750) Regulation .03 amended effective April 7, 2008 (35:7 Md. R. 750); March 28, 2016 (43:6 Md. R. 409) Regulation .04 amended effective January 15, 1996 (23:1 Md. R. 29); September 30, 2002 (29:19 Md. R. 1525); April 7, 2008 (35:7 Md. R. 750); May 2, 2011 (38:9 Md. R. 553); March 28, 2016 (43:6 Md. R. 409) Regulation .04E amended effective November 10, 2003 (30:22 Md. R. 1583) Regulation .04F amended effective September 7, 1987 (14:18 Md. R. 1967) Regulation .04I amended effective April 20, 2009 (36:8 Md. R. 596) Regulation .05 amended effective March 28, 2016 (43:6 Md. R. 409) Regulation .05F amended effective May 2, 2011 (38:9 Md. R. 553) Regulation .07 amended effective September 30, 2002 (29:19 Md. R. 1525) Regulation .08 amended effective September 30, 2002 (29:19 Md. R. 1525) Regulation .08A amended effective January 15, 1996 (23:1 Md. R. 29) Regulation .09 adopted effective April 20, 2009 (36:8 Md. R. 596) Regulation .09B amended effective March 28, 2016 (43:6 Md. R. 409) Annotation: COMAR 11.17.03.04D(2) cited in Attorney General Opinion No. 83-020 (May 23, 1983) Annotation: COMAR 11.17.03.02 cited in Attorney General Opinion No. 86-030 (May 6, 1986)