FMCSA has no standard specific to non-insulin-treated diabetes, but certified medical examiners can use this optional four-page form, revised 1/26/24, to ask the driver's treating provider for details. The answers on medications, monitoring, glucose control, hypoglycemic and hyperglycemic episodes, HbA1c, complications and retinopathy help the examiner judge whether the driver can operate a commercial vehicle safely.
The certified medical examiner fills in and signs the request on page 1. The driver's treating health care provider answers questions 1 to 11 and signs with license number and state.
Download the current version from the source each time; forms change without notice.
Non-Insulin-Treated Diabetes Mellitus Assessment Form
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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No. It is an optional tool examiners may use to gather information on the diagnosis, monitoring and stability of non-insulin-treated diabetes. The final decision on physical qualification rests with the certifying medical examiner, who weighs complications and target organ damage.
Renal disease, cardiovascular disease such as coronary disease, hypertension, TIA or stroke, autonomic neuropathy, peripheral neuropathy, lower-limb problems such as foot ulcers or amputations, and any other complication, each with diagnosis date, treatment and stability, plus severe nonproliferative or proliferative diabetic retinopathy.