Free Printable Dot Physical Forms 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 As part of the physical drivers are required to fill out the medical history portion of the Medical Examination Report MER Form MCSA 5875
A Medical Examination Report Form MCSA 5875 cannot be amended after an examination has been in determination pending status for more than 45 days or after a final qualification determination has been made The driver is required to obtain a new physical examination and a new Medical Examination Report Form MCSA 5875 should be completed New CDL Drivers DOT Medical Exam Form MCSA 5875 and CDL Medical Card Certificate MCSA 5876 This form is mandatory after April 16 2016 for all DOT CDL Physicals and replaces the old form 649f Includes Instructions to Physician Minimum Requirements Physical Qualifications and CDL Medical Certificate for Commercial Drivers PDF format
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New DOT Medical Certification Forms MCSA 5875 MCSA 5876 January 3 2024Trucker Docs This article has been updated a number of times as new information regarding Medical Examiner s Certification has been published by FMCSA We have left the history of this blog post and updated the latest information at the top of the page The Medical Examiner will keep a copy of the Medical Examiner s Certificate MEC Form MCSA 5876 on file for at least 3 years About the Medical Examiner s Certificate MEC Form MCSA 5876If the Medical Examiner determines that the driver examined is physically qualified to drive a commercial motor vehicle in accordance with the physical
Medical Examination Report MER Form MCSA 5875 PDF 456 KB This form is an example of what patients can expect The MER will be completed online at the center and does not need to be printed and completed beforehand Medical Examiner s Certificate MEC Form MCSA 5876 PDF 91 7 KB This form is an example of what certified drivers 391 41 CMV Driver Medication Form MCSA 5895 If requested by a DOT medical examiner have this form completed by a driver s prescribing healthcare provider Insulin Treated Diabetes Mellitus Assessment Form MCSA 5870 Have this form completed by a driver s treating clinician and submit it to the DOT medical examiner within 45 days
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A Medical Examination Report Form MCSA 5875 cannot be amended after an examination has been in determination pending status for more than 45 days or after a final qualification determination has been made The driver is required to obtain a new phys ical examination and a new Medical Examination Report Form MCSA 5875 should be completed Form MCSA 5876 OMB No 2126 0006 Expiration Date 12 31 2024 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 Paperwork Reduction Act unless
Fill out your Medical Self Certification form and include a copy of your DOT physical card You can mail or fax this information to Driver Licensing Docking State Office Building Attn Medical Cert P O Box 2188 Topeka KS 66601 2128 Fax 785 296 5859 Form BMC 85 Property Broker s Trust Fund Agreement Under 49 U S C 13906 or Notice of Cancellation of the Agreement Form BOC 3 Designation of Agents for Service of Process Form MCS 82 Motor Carrier Public Liability Surety Bond under Sections 29 and 30 of the Motor Carrier Act of 1980
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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 As part of the physical drivers are required to fill out the medical history portion of the Medical Examination Report MER Form MCSA 5875
https://www.fmcsa.dot.gov/sites/fmcsa.dot.gov/files/2022-03/Medical%20Examination%20Report%20Form%20MCSA-5875.pdf
A Medical Examination Report Form MCSA 5875 cannot be amended after an examination has been in determination pending status for more than 45 days or after a final qualification determination has been made The driver is required to obtain a new physical examination and a new Medical Examination Report Form MCSA 5875 should be completed
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Free Printable Dot Physical Forms - 391 41 CMV Driver Medication Form MCSA 5895 If requested by a DOT medical examiner have this form completed by a driver s prescribing healthcare provider Insulin Treated Diabetes Mellitus Assessment Form MCSA 5870 Have this form completed by a driver s treating clinician and submit it to the DOT medical examiner within 45 days
