Dot Medical Card Form Printable About the Medical Examination Report MER Form MCSA 5875The Federal Motor Carrier Safety Administration requires that interstate commercial motor vehicle drivers maintain a current Medical Examiner s Certificate MEC Form MCSA 5876 to drive
If the Medical Examiner determines that the driver examined is physically qualified to drive a commercial motor vehicle in accordance with the physical qualification standards the Medical Examiner will complete and provide the driver with a Medical Examiner s Certificate MEC Form MCSA 5876 MCSA 5876 Form Form MCSA 5876 Revised 12 06 2015 OMB No 2126 0006 Expiration Date 8 31 2018 Public Burden Statement A Federal agency may not conduct or sponsor and a person is not required to respond to nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the
Dot Medical Card Form Printable
Dot Medical Card Form Printable
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SECTION 1 Driver Information to be filled out by the driver PERSONAL INFORMATION Last Name First Name Middle Initial Date of Birth Street Address City State Province Driver s License Number Issuing State Province E Mail optional CLP CDL Applicant Holder Zip Code Phone Yes No Age Driver ID Verified By The physical qualifications FMCSA regulations and guidelines to be applied by a medical examiner to qualify drivers for a medical card have not changed even though the forms have changed since 2015 What this means for drivers Wiser Is Better Choose Your DOT Physical Doctor Wisely
DMV can only accept a Medical Examiner s Certificate MEC MCSA 5876 also known as a medical card or DOT card The MEC fits on a single page and includes the MEC expiration date View a sample of the form to ensure you are providing the proper document to DMV M F No Driver ID Verified By Has your USDOT FMCSA medical certificate ever been denied or issued for less than 2 years Yes No Not Sure CLP CDL Applicant Holder See instructions for definitions Driver ID Verified By Record what type of photo ID was used to verify the identity of the driver e g CDL driver s license passport
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DOT Medical Examination Forms Certificate download FMCSA Commercial Driver Fitness Determination truck bus drivers All Medical Forms Medical Examination Report Form MER MCSA 5875 Medical Examiner s Certificate MEC MCSA 5876 Insulin Treated Diabetes Mellitus Assessment Form MCSA 5870 DOT Physical Providers Add a Directory Listing as low as 99 95 yr DOT Physical Form Medical Card Certificate Forms MCSA 5875 MCSA 5876 in PDF Free to Print or Download Includes Instructions to Physician and Commercial Drivers Minimum Requirements for a CDL License
Medical Examination Report Form Form MCSA 5875 Medical Examiner s Certificate Form MCSA 5876 Notice to Health Care Providers Regarding Medical Examiner s Certificate PDF Pennsylvania Commercial Driver s Manual PDF Self Certification Guide PDF Drivers required to maintain a certified medical status must provide a U S Department of Transportation medical examiners certificate to the N C Division of Motor Vehicles by visiting a driver license office emailing it to CDLmedical ncdot gov or mailing it to N C Division of Motor Vehicles CDL Medical Certification Unit
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https://www.fmcsa.dot.gov/regulations/medical/medical-examination-report-form-commercial-driver-medical-certification
About the Medical Examination Report MER Form MCSA 5875The Federal Motor Carrier Safety Administration requires that interstate commercial motor vehicle drivers maintain a current Medical Examiner s Certificate MEC Form MCSA 5876 to drive
https://www.fmcsa.dot.gov/regulations/medical/medical-examiners-certificate-commercial-driver-medical-certification
If the Medical Examiner determines that the driver examined is physically qualified to drive a commercial motor vehicle in accordance with the physical qualification standards the Medical Examiner will complete and provide the driver with a Medical Examiner s Certificate MEC Form MCSA 5876
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Dot Medical Card Form Printable - SECTION 1 Driver Information to be filled out by the driver PERSONAL INFORMATION Last Name First Name Middle Initial Date of Birth Street Address City State Province Driver s License Number Issuing State Province E Mail optional CLP CDL Applicant Holder Zip Code Phone Yes No Age Driver ID Verified By
