What should a clinical exam for a license to carry a firearm include?

Clinical Examination for License to Carry a Firearm

A comprehensive clinical examination for a license to carry a firearm should include a thorough mental health assessment, medical evaluation for conditions that could impair safe handling of firearms, and specific counseling about firearm safety measures.

Mental Health Assessment

The mental health component should focus on identifying risk factors that could impair judgment or increase risk of harm:

• Suicide risk assessment:

  • History of suicidal ideation or attempts
  • Current depressive symptoms
  • Substance abuse issues (particularly alcohol)
  • Recent significant life stressors 1

• Violence risk factors:

  • History of violent behavior
  • Exposure to family violence
  • Antisocial behavior
  • Drug/alcohol use
  • Bullying behaviors 1

• Psychiatric conditions requiring evaluation:

  • Mood disorders (depression, bipolar disorder)
  • Psychotic disorders
  • Posttraumatic stress disorder
  • Panic attacks
  • Severe anger issues 1

Medical Evaluation

The medical component should assess conditions that could impair safe firearm handling:

• Neurological assessment:

  • Cognitive function
  • Motor coordination
  • Visual acuity and peripheral vision
  • Sensory function, particularly in hands and right foot 1

• Cardiovascular assessment:

  • For individuals over 45 (men) or 55 (women) planning vigorous activity
  • Medical history, physical examination, and risk factor profile
  • Consider electrocardiographic stress test if indicated 1

• Screening for conditions that may impair consciousness:

  • History of syncope or seizures
  • Sleep disorders including obstructive sleep apnea
  • Hypoglycemic episodes (for diabetic patients)
  • Medication side effects that could impair alertness 1

Specific Diabetes Considerations

For patients with diabetes, the examination should include:

• Assessment of hypoglycemia awareness
• Questions about any episodes within the past 12 months of:
  • Loss of consciousness due to hypoglycemia
  • Hypoglycemia requiring assistance from another person
  • Hypoglycemia that interfered with driving 1

Firearm Safety Counseling

The clinical examination should include specific counseling about:

• Safe storage practices:

  • Keeping firearms unloaded in specialized or tamper-proof safes
  • Separately locking ammunition
  • Restricting access to keys or lock combinations 1

• Means restriction counseling for households with vulnerable individuals:

  • Households with adolescents (especially those with mood disorders)
  • Households with individuals with substance abuse issues
  • Households with individuals with history of suicidal behavior 1

Documentation and Reporting

The clinician should document:

• All risk assessments performed
• Any identified concerns that may impact safe firearm handling
• Specific safety recommendations provided
• Whether the individual meets criteria for safe firearm handling

Important Considerations and Pitfalls

• State-specific requirements: Clinicians should be familiar with their state's specific laws regarding firearm licensing, as these vary significantly across jurisdictions 2

• Confidentiality considerations: Be aware of state-specific reporting requirements and confidentiality laws when conducting these evaluations 2

• Avoid common pitfalls:

  • Failing to document thorough mental health assessment
  • Not considering medication effects that could impair judgment
  • Overlooking medical conditions that could affect safe handling
  • Neglecting to provide specific safety counseling 3, 4

• Public perception: Most adults (76-89%) believe clinicians should discuss firearm safety in relevant clinical contexts, so don't hesitate to have these conversations 5

By following this comprehensive approach, clinicians can conduct thorough evaluations that prioritize public safety while respecting individuals' rights to firearm ownership when appropriate.