All commercial drivers of vehicles in interstate commerce with a maximum gross vehicle weight rating of over 10,000 pounds 4,536 kilograms are required to obtain and maintain a valid medical examiners certificate me certificate commercial drivers who drive vehicles requiring a cdl have two additional requirements. Driver id verified by medical examiner or staff records what type of photo id was used to verify the identity of the driver e. Dot safety regulations require commercial drivers to renew their physical every 2 years. This commercial driver fitness determination form is required by 49 cfr 391. About the medical examination report mer form, mcsa5875the federal motor carrier safety administration requires that interstate commercial motor vehicle drivers maintain a current medical examiner s certificate mec, form mcsa5876 to drive. Help stay in compliance with labelmasters medical examiners certificate wallet card. Download this resource to view table of contents and enable bookmark feature. The information i have provided regarding this physical examination is true and complete. An integral part of the driver qualification file, this is required to be carried by every driver of a commercial motor vehicle as a proof of medical qualification in 49 cfr 391. The federal motor carrier safety administration requires that interstate commercial motor vehicle drivers maintain a current medical examiners certificate mec, form mcsa5876 to drive. About the medical examination report mer form, mcsa5875the federal motor carrier safety administration requires that interstate commercial motor vehicle drivers maintain a current medical examiners certificate mec, form mcsa5876 to drive. The commercial driver medical examiner course overview module 1 education save the date.
Under the new requirement by the federal motor carrier safety administration, all states must begin collecting and maintaining medical certification information. Fill medical examination report form for commercial driver medical certification for minnesota, edit online. The driver medical examination report dmer is the primary tool used by the. As a medical examiner, your fundamental obligation is to establish whether a driver has a disease, disorder, or injury resulting in a higher than acceptable likelihood for gradual or sudden incapacitation or sudden death, thus endangering public safety. New cdl drivers dot medical exam form, mcsa5875, and cdl medical card certificate, mcsa5876. The form, mcsa5875, includes a medical examiners certificate mcsa5876 that is signed by a health care professional, when the driver meets the federal requirements. This is a directory of dot cdl license physical exam locations throughout the. Obtain a commercial drivers license learners permit. New dot physical forms 2015 fmcsa answers questions from. Insulintreated diabetes mellitus assessment form, mcsa5870. As part of the physical, drivers are required to fill out the medical history portion of the medical examination report mer. Make sure your drivers are medically qualified to be on the road with labelmasters truck driver medical examination report.
The 8 requirements for a driver qualification file apex. A cdl skills exam must be taken at one of the authorized cdl driving skills exam. Dot medical examination formscertificate download dot. Drivers medical examination report dmer province of british. The carrier must retain a copy of this certificate. Medical examiners certificate for commercial driver medical certification u. Medical examination report of driver under article 19a. The medical examiners certification integration final rule requires certified mes to continue using the current driver examination forms found on the fmcsa website until december 22, 2015 and to use the newly revised driver. The commercial motor vehicle driver medical examination aims to ensure. Medical federal motor carrier safety administration. Medical examination report and medical examiners certificate 49 cfr 391. Medical examiners are required to complete the medical examination report form for every driver physical examination performed in accordance with 49 cfr 391. Medical examiners certificates cards not long forms should be sent to. Commercial drivers license cdl medical certification.
Temporary permit for transportation of hazardous materials. Medical examination certificate laminated jj keller. Medical examination report form for commercial driver medical certification. Please note that these questions are answered as they pertain to the current medical examiner report form mer and medical examiners certificate mec, and not the new forms. The official nebraska department of motor vehicles dmv.
Discuss any yes answers in detail in the space below, and indicate whether it would affect the drivers ability to operate a. The applicant is required to submit copies of the medical examination report and medical examiners certificate. Commercial driver license medical selfcertification form. Medical applications and forms medical examinations. This form is mandatory after april 16, 2016 for all dot cdl physicals and replaces the old form 649f. Comment on the drivers responses to the health history questions that may affect the drivers safe operation of a commercial motor vehicle cmv. Every carrier must also retain a note or record in the dqf verifying that the medical examiner used by the truck driver was authorized on the national registry of certified medical examiners list. Vehicle light permit amber, red, blue publications and reports. Medical examination report for commercial driver fitness determination 1. To initiate an appeal, you will be required to submit a detailed medical report.
Fmcsa report on medical conditions and commercial driving how medical. The commercial driver medical examination determining the medical fitness of the commercial driver course overview and module 1 overview. The date found on the top right corner of the medical. As part of the physical, drivers are required to fill out the medical history portion of the medical examination report mer form, mcsa5875. Fmcsa form mcsa5875 us department of transportation.
Medical examination report mcsa5875 federal motor carrier 21260006 expiration date. The commercial motor vehicle driver medical examination aafp. Medical examination report mer form, mcsa5875 federal. Course curriculum medical examiner dot training nadme. Selfcertification medical examiners certification dmv. Dotmedical informationintrastate dps driver license. Commercial driver license medical eligibility california. Medical has your usdotfmcsa medical certificate ever been denied or issued for less than 2 years.
New dot physical forms 2015 fmcsa answers questions from medical examiners regarding submitting cmv driver exams. This live activity, commercial driver medical examiner training. Each original paper or electronic completed medical examination report form must be retained on file at the office of the medical examiner for at least 3 years from the date of. Medical examination for motor vehicle operators government of. Driver must carry certificate when operating a commercial vehicle. Driver medical evaluation ds 326 pdf back to main forms page. Cdl drivers dot medical exam form certificate mcsa 5875 pdf. A medical certificate from a federally registered medical examiner must be obtained to be a uhaul cmv driver. Medical examiners performing commercial driver medical exams must be listed on the. A complete medical examination report form, mcsa5875, with any attachments embodies my findings completely and correctly, and is on file in. Download fmcsa dot physical medical forms and state department of motor vehicles self certification forms and medical examiners certificate. Cdl drivers who certify to either a nonexcepted interstate or nonexcepted intrastate category of commercial motor vehicle cmv operation must have their physical examiners certificate completed by a medical examiner who is listed on the federal motor carrier safety administrations fmcsas national registry of medical examiners. The federal motor carrier safety administration requires that interstate commercial motor vehicle drivers maintain a current medical examiners. View a sample medical examination certificate laminated.
A department of transportation dot physical examination must be conducted by a licensed medical examiner listed on the federal motor carrier safety administration fmcsa national registry. The medical examiners certificate report and wallet card is an integral part of the driver qualification file. The newly designed driver card fits any standard size wallet. Commercial driver medical examination report georgia. Nj mvc cdl selfcertification and medical examiner certificate. Sample federal motor carrier safety administration frequently asked. Even if a condition does not disqualify a driver, the medical examiner may consider deferring the driver temporarily. The complete standards and instructions for conducting this examination are found in section 6.
Nadmes online dot medical examiner training course conforms to the federal motor carrier safety administrations fmcsa training curriculum addressing regulations and guidelines for conducting cmv driver medical examinations. If your physician chooses to use this process, be sure that you complete the form prior to returning it to the driver safety office. Also, the driver should be advised to take the necessary steps to correct the condition as soon as. Dot medical exam and commercial motor vehicle certification about the exam. Pass a dot physical examination and provide the bmv with an valid medical examination report mer and medical examiners certificate mec. Drivers information driver must complete this section. Driver selects one of the four categories if any apply. Pass a skills test in a vehicle class you intend to operate.
To record results of a drivers physical examination, to determine qualification to operate a commercial motor vehicle cmv, and to. Medical examination report for commercial driver fitness. Medical examination report mer form, mcsa5875 fmcsa. This medical examination report must remain on file with the department. Drivers are encouraged to keep the original medical report and fax. At regular intervals when a person holds a commercial class drivers licence. Medical standards for class g drivers driving for commercial. The medical examiners certificate wallet card is required to be carried by every driver of a commercial motor vehicle as a proof of medical qualification in 49 cfr 391. Commercial driver license selfcertification and medical examiner certificate.
The dot physical examination is conducted by a licensed medical examiner. We laminate a wallet medical card for tom, give him copies of the medical examiners certificate and long form. Medical examination report for a group 2 lorry or bus licence ref. Medical examination report form with certificate mcsa 5875. Below is a sample copy of the driver medical examination report required for. Federal motor carrier safety administration fmcsa regulations 49 c. Dot physical form fill online, printable, fillable, blank pdffiller. Applicants seeking a commercial drivers license or renewing or transferring their cdl will be required to provide proof of medical certification under a federal law that takes effect at the end of january 2012. Alternatively, medical providers with access to the internet can print the dme, complete and sign it, and forward it to the driver. Nys dmv mc11a medical certification requirements for commercial driver. Truck driver medical examination report labelmaster.
Medical examination report for commercial driver fitness determination. You will be required to self certify to a single type of commercial operation on your driver license application form. Any driver who drives for commerce in a vehicle with a gross weight rating of 10,001 pounds is required to have a dot medical card in their possession. Medical standards for drivers and as a result will be ineligible to be licensed at. Examination report form and medical examiners certificate as found on the fmcsa website until december 22, 2015. Medical examiners name address return to medical examiners office for follow up on telephone number if meets standards, complete a medical examiners certificate as stated in 49 cfr 391. Commercial drivers are required to certify using penndots selfcertification form dl11cdpdf. To obtain and maintain a cdl you may be required to have a dot medical card. The federal motor carrier safety administration requires that interstate commercial motor vehicle drivers maintain a current medical examiner s certificate mec, form mcsa5876 to drive. To obtain a cdl, the applicant must provide a valid medical examination report for commercial driver fitness determination and medical examiners certificate medical report and medical examiners certificate, pass applicable vision and knowledge tests, obtain a commercial drivers license learners permit clp and pass. Medical examination report for a lorry or bus driving. Temporarily disqualified due to condition or medication.