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DOT Shy Bladder Evaluation (49 CFR 40.193)

When a DOT-tested employee cannot provide a sufficient urine specimen within three hours, or oral fluid within one hour, 49 CFR 40.193 requires a medical evaluation within five days. A referral physician acceptable to the Medical Review Officer (MRO) recommends whether a medical condition precluded the specimen, and the MRO decides between a cancelled test and a refusal to test.

Who completes it

A licensed physician acceptable to the MRO, with expertise in the medical issue raised, performs the evaluation and writes the recommendation; the MRO may do it if they have the expertise. The employer's DER directs the employee to the evaluation after consulting the MRO.

Submitting and payment

How to submit it
The physician gives the MRO a written statement of the recommendation and its basis; the MRO reports the determination to the employer's DER in writing.

Good to know

  • A qualifying medical condition is an ascertainable physiological condition, such as urinary system dysfunction or, for oral fluid, an autoimmune disorder, or a documented pre-existing psychological disorder.
  • Unsupported claims of situational anxiety or dehydration do not count as a medical condition under 40.193(e).
  • The statement to the MRO should include no more medical detail than needed to explain the conclusion.
  • For pre-employment, return-to-duty or follow-up tests, a serious and permanent or long-term disability must be stated with reasons, and the MRO then applies 40.195.

Read the official requirements

The issuer sets what the letter or report must contain; check its current rules before you write it.

Insufficient specimen (shy bladder) medical evaluation - referral physician recommendation (49 CFR 40.193)

Official page

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Frequently asked questions

Who can perform a DOT shy bladder evaluation?

A licensed physician who is acceptable to the Medical Review Officer and has expertise in the medical issues raised by the failure to provide a sufficient specimen. The MRO may perform it with appropriate expertise. Before referral, the MRO tells the physician about the test, the consequences of refusal and the rule's requirements.

What does the referral physician recommend?

One of two determinations: that a medical condition has, or with a high degree of probability could have, precluded a sufficient specimen, which leads the MRO to cancel the test; or that there is no adequate basis for that finding, which leads the MRO to record a refusal to test.

Is there a DOT form for the shy bladder medical evaluation?

No. The physician writes a statement of recommendations and their basis to the MRO, as 49 CFR 40.193(f) requires. The collection itself is documented on the Federal Drug Testing Custody and Control Form, where the MRO checks Test Cancelled or Refusal to Test.