Printable Dot Medical Card Form 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
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 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
Printable Dot Medical Card Form
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Form MCSA 5876 M No Eiration Date 2 31 202 MEDICAL EXAMINER S CERTIFICATE for Commercial Driver Medical Certification 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 Doctors Only Find a DOT Doctor 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
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 Has your USDOT FMCSA medical certificate ever been denied or issued for less than 2 years Yes No Not Sure Medical Examination Report Form Safety Administration for Commercial Driver Medical Certification SECTION 1 Driver Information to be filled out by the driver MEDICAL RECORD or sticker PERSONAL INFORMATION Last Name First Name Middle Initial Date of Birth Street Address City State Province Driver s License Number
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Physical Examination Form Connecticut CDL Self Certification Form electronic DOT Physical form R 323 Medical Examiner s Certificate You are required to fax your medical certification to FAX 860 263 5568 New Jersey CDL nj med cert affidavit CDL FAQs 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 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 As a Commercial Driver s License CDL holder you are required to submit a medical report dated within the last two years every two years You are required to submit A valid original or copy federal MER MCSA 5875 form Medical Examiner s Certificate Form MEC MCSA 5876
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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
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
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Printable Dot Medical Card Form - Doctors Only Find a DOT Doctor 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
