Except where absolute criteria exist (i.e., a current clinical diagnosis of alcoholism), as a medical examiner, you make the final determination as to whether the driver meets the Federal Motor Carrier Safety Administration (FMCSA) medical standards for driver certification. Use whatever tools or additional assessments you feel are necessary. If the driver shows signs of alcoholism, have the driver consult a specialist for further evaluation.

If you believe immediate testing for alcohol is warranted, contact FMCSA or contact the employer of the driver directly for information on controlled substances and alcohol testing under Part 382 of the Federal Motor Carrier Safety Regulations.
A driver MUST submit to alcohol testing if there is reasonable suspicion that the U.S. Department of Transportation (DOT) prohibitions concerning alcohol are violated. Suspicion MUST be based on specific observations concerning driver behavior, speech, or body odor.
If you have a patient in which you suspect drug and or alcohol abuse and you have the driver get an SAP evaluation during which the SAP says that the driver is able to drive (or does not have abuse etc) does the driver need a new physical exam?

Just as with referral opinion from any PMD or specialist, don’t need a new exam, just document in the comments section that the SAP eval was negative and you are certifying the driver for ______ period of time, or create a new form marked “follow up” –now, you may want to see the driver back sooner than 2 yrs based on your judgement, but you better have a well documented reason why.

As in the case of Scenario #1 say the SAP felt that the driver had done enough rehab and that she was sober and did not need more and was “cleared” again does the driver need another physical or what are the paperwork requirements from the ME who had already said that the driver was disqualified?
If the driver was disqualified, went through any type of treatment, rehab, surgery, whatever,  and the motor carrier sends them back for re-certification, they need a new exam.
Who may serve as an SAP? Is there a specific list of people that the DOT has approved or is it just trained people in the community?

There are no DOT approved SAPs— but there are stringent requirements to be a SAP — It is up to the motor carrier to provide an SAP evaluation–this is from the DOT SAP guidelines:

 1. Under the DOT rules, must a SAP be certified by DOT in order to perform SAP functions?

DOT does not certify, license, or approve individual SAPs. However, the SAP must be able to demonstrate to the employer qualifications necessary to meet DOT rule requirements. Part 40 states that the SAP must be a licensed physician (Doctor of Medicine or Osteopathy); or a licensed or certified social worker; or a licensed or certified psychologist; or a licensed or certified employee assistance professional; or an alcohol and drug abuse counselor certified by the National Association of Alcoholism and Drug Abuse Counselors Certification Commission (NAADAC) or by the International Certification Reciprocity Consortium/Alcohol and Other Drug Abuse (ICRC). Additionally, there are specific knowledge, training, examination, and continuing education requirements that SAPs must satisfy.

Here is a resource for finding SAPs:  SAP List

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