What must accompany the certification for a pacemaker?

When certifying a driver with a pacemaker, it is essential to have documentation confirming the proper functioning of the pacemaker. This ensures that the medical examiner has clear evidence that the device is operating normally and that the driver does not have any restrictions or conditions that could impair their ability to drive safely. The documentation serves to verify that the pacemaker is actively managing the individual's heart rhythm appropriately and that they are stable enough to operate a vehicle, thereby reducing the risk of medical emergencies on the road.

While other options may provide additional health information, they do not specifically validate the pacemaker's function, which is critical for ensuring safety in driving. A blood test, proof of physical activity, or an electrocardiogram report might pertain to overall health but would not substitute for the direct confirmation needed about the pacemaker's status.