What does 49 CFR 40.195 (What happens when an individual is unable to provide a sufficient amount of specimen for a pre-employment, follow-up, or return-to-duty test because of a permanent or long-term medical condition?) require?

Based on 49 CFR 40.195, when an applicant or employee cannot provide a sufficient urine specimen for a pre-employment, follow-up, or return-to-duty test due to a permanent or long-term medical condition, the Medical Review Officer (MRO) must handle the situation as follows:

1. Medical Evaluation: The MRO must determine if there is clinical evidence that the individual is an illicit drug user by personally conducting—or having a licensed physician acceptable to the MRO conduct—a medical evaluation. This includes consulting with the employee's physician and/or the evaluating physician. Alternative tests (such as a blood test) may be used during this evaluation.

2. If No Clinical Evidence of Drug Use is Found: The MRO must report the result to you, the motor carrier, as a negative test. The MRO will provide written documentation detailing the evaluation results, the basis for determining that a permanent or long-term medical condition prevents providing a sufficient specimen, and the basis for determining that no signs or symptoms of drug use exist. The MRO will check "Negative" on the Custody and Control Form (CCF) and sign and date it.

3. If Clinical Evidence of Drug Use is Found: The MRO must report the result to you as a cancelled test. The report will include written notations on the evaluation results, confirm the permanent or long-term medical condition, and state the reasons for finding signs and symptoms of drug use.

*Practical note for employers:* Because a cancelled test does not serve the purpose of a negative test, you are not authorized to allow the individual to begin or resume performing safety-sensitive functions based on a cancelled test result under this section.