Detroit Lakes
1361 Wenner Road
Detroit Lakes, MN 56501
(218) 846-9981
Moorhead
North Fargo
720 Main Ave
1100 19th Ave N, Suite M
Moorhead, MN 56560
Fargo, ND 58102
(218) 359-0399
(701) 356-1150
Osgood-Fargo
4622 40th Ave S
Fargo, ND 58104
(701) 364-2909
South Fargo
1517 32nd Ave S
Fargo, ND 58103
(701) 232-6211
Department of Transportation (DOT) CME Letter regarding:
Neurology Condition
Effective May 21st, 2014, Commercial Driver’s License (CDL) or DOT physicals can only
be done by providers who have completed training and testing to be a Certified Medical
Examiner (CME). CMEs are responsible for determining medical fitness for duty, not
diagnosing and treating medical conditions. Diagnosing and treating medical
conditions is the responsibility of the driver and his/her primary care provider (PCP).
National criteria are in place for who can and cannot drive, and in order to be
considered for certification, the following patient will require additional information from
his/her PCP to continue the DOT certification process.
Patient Name
Patient DOB
7-Day CME
Date of Service for DOT Evaluation
Pt. PCP/Specialist
Because of the indicated underlying health conditions, new regulations make it
imperative that the patient receives a neurology consult due to his/her evaluation.
☐History of Seizures
☐History of TBI
☐History of Stroke or TIA
☐Other:__________________________________
The consult must contain certain tests and opinions. There is a checklist of information
our CMEs will need to know attached.
Please complete this form and return with additional requested information to your
patient AND our office at your earliest convenience.
7-Day Clinic DOT Consult Information
1100 19th Ave N, Suite M
Fargo, ND 58102
Fax (701) 364- 9346 ATTN: DOT Consult Information
Here is the information needed from SPECIALIST and/or PCP and returned to the
patient and 7 Day Clinic CME on PCP or Specialist’s letterhead/ notes.
Patient Name and Date of Birth
Patient Diagnosis
Patient Medication List
If history of seizures, please have the below listed in chart notes of your neurological
examination and assessment:
☐ Seizure Free Period
☐ Length and time of Anticonvulsants
☐ Normal Physical Examination
☐ Neuro-Ophthalmological Evaluation Done
☐ Neuropsychological Testing If Done
If history of Stroke or TIA, please have the below listed in chart notes of your
neurological examination and assessment:
☐ Date of Last Visit
☐ Cognitive Abilities
☐ Judgement
☐ Attention
☐ Concentration
☐ Vision
☐ Physical Strength and Agility
☐ Reaction Time
☐ Type of Stroke
☐ Time from the Stroke
The minimum waiting periods for certification for CDL licensure following a
Stroke or TIA are:
-For Embolic and Thrombotic Strokes, the minimum waiting periods are
1 year if not at risk for seizures (cerebellum or brainstem vascular lesions)
5 years if at risk for seizures (cortical or subcortical deficits)
-For strokes without risk for seizures, Intracerebral or subarachnoid hemorrhage without
risk for seizures, the minimum waiting period is one year
-For Stroke with risk for seizures, if Intracerebral or subarachnoid hemorrhage with risk
for seizures, the minimum waiting period is 5 years seizure free and off seizure
medication.
If history of TBI, please have the below listed in chart notes of your cardio logical
examination and assessment:
Mild or Moderate TBI
☐ Completed the minimum Waiting period seizure free and Anticonvulsant
Medication
☐ Seizure Free
☐ Normal Physical Examination
☐ Neurological Examination including Neuro-opthalmology Evaluation
☐ Normal Neuropsychological Testing
Sever TBI is an automatic disqualification for certification.
The minimum waiting periods for certification for CDL licensure following a
traumatic brain injury are:
-Mild injury without early seizures, 1 year seizure free and off anticonvulsant medication
following:
-Moderate insult without early seizures OR mild insult with early seizures, minimum 2
years seizure free and off anticonvulsant medication.
-Moderate insult with early seizures, minimum 5 years seizure free and off
anticonvulsant medication.
With any of these items, please make sure to include all test results in your notes to our
CMEs.
If you have any other concerns about the patient or feel as if the patient should not be
cleared, please record it in the examination/assessment notes or on your personal letter
head.
Thank you so much for your assistance with your patient obtaining a CDL license.
Please complete this checklist on you letterhead/notes and return with additional
requested information to your patient AND our office at your earliest convenience.
7-Day Clinic DOT Consult Information
1100 19th Ave N, Suite M
Fargo, ND 58102
Fax (701) 364- 9346 ATTN: DOT Consult Information