For Maine drivers with narcolepsy, the treating clinician can supplement the CR-24 Driver Medical Evaluation with this one-page Word addendum. It captures treatment type, effectiveness and adherence, the Epworth Sleepiness Scale score, and whether cataplexy is present, how often, how predictable and what triggers it. These are the details Maine's Functional Ability Profile rules ask clinicians to document.
The clinician treating the narcolepsy completes and signs the whole addendum. Maine's rules note these patients are usually followed by a sleep specialist, neurologist or pulmonologist, or their nurse practitioners and physician assistants.
Download the current version from the source each time; forms change without notice.
Narcolepsy/Cataplexy Addendum
This form is a Word template, not a PDF. Vero Scribe writes the visit note it draws on, so the details are ready when you complete it.
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Whether cataplexy is present, the date of the last event, how often episodes occur, whether they are predictable, what triggers them, and a description of the circumstances and symptoms. Maine's rules note that narcolepsy with cataplexy may increase the risk of unsafe driving.
The addendum has a field for the Epworth Sleepiness Scale score, alongside the type, effectiveness and adherence of treatment. Maine's guidance stresses documenting the degree of residual daytime sleepiness when the BMV reviews drivers with narcolepsy.