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. Me determines if driver meets physical qualification standards. Skill performance evaluation certificate application new driver application package. The summary of your visit can be sent to your primary care provider with your permission. Requirements the federal diabetes and vision driver.
Medical examination report for commercial driver fitness determination merform, mcsa5875, long form. About the medical examination report mer form, mcsa5875. Kentucky transportation cabinet division of driver licensing tc 94 35 rev. Commercial driver fitness determination specialist somerset. The commercial motor vehicle driver medical examination. Onpoint urgent care also offers dot drug and alcohol testing. Before we issue the medical examination report that you need, we put you through driver fitness determination tests that include a series of medical exams. As part of the physical, drivers are required to fill out the medical history portion of the medical examination report. Medical examination report for commercial driver fitness determination 2. For example, if a driver is operating with an expired medical certificate, then he or she is not complying with the driver fitness basic.
General information federal motor carrier safety regulations advisory criteria. Selfcertification and valid medical certificates help prevent medically unqualified drivers from operating commercial vehicles. Dot physical onpoint urgent care of aurora, highlands ranch. The purpose of this examination is to determine a drivers physical qualification to operate a commercial motor vehicle. As part of the physical, drivers are required to fill out the medical history portion of the medical examination report mer form, mcsa5875. Department of transportation federal motor carrier safety administration public burden statement. School bus driver physicals medical examination report of driver under article 19a. Medical examination report, dotcertified miami, fl. Florida school bus operators medical examination report for. Dot cdl medical physical examination for commercial driver fitness determination. Commercial motor vehicle cmv driver medical examination results form mcsa5850, an electronic form examiners complete through the national registry website to report exam. Driver s information driver completes this section date of exam m recertification m d y driver s name last, first, middle social security no.
Canvas medical examination report for commercial driver. Driver medical fitness for duty drivers are critical to highway safety. Skill performance evaluation certificate application renewal package. Ada information wv dot privacy notices contact us site map disclaimer west virginia code for more information, please call 18006429066 west virginia. Our dot physical is the quickest and most convenient dot medical exam on all of long island nassau, suffolk, queens. If you need, we can fax the dot physical form and certificate to your company. Health history for any yes answer, indicate onset date, diagnosis, treating physicians name and. New guidelines and medical examiner report as of september 30, 2004, the fmcsa requires the use of the new form, medical examiner report for commercial driver fitness determination, which reflects the revised blood pressure guidelines. Drivers information drivers name last, first, middle social security no. Commercial driver fitness determination specialist. A final update regarding posting and use of driver examination forms was published in the federal register allowing mes to use both the current and newly revised versions of the medical examination report form and medical examiners certificate from december 22, 2015 until april.
Cdl truck drivers, non cdl truck drivers, mta bus drivers. Form popularity medical examination report for commercial driver fitness determination form. Drivers information driver completes this section date of exam m recertification m d y. Dot medical examination formscertificate download dot.
Urine drug testing for new york, ny dot medical examiner. Please mail the selfcertification form and medical certificate if. 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. Our staff will complete the remaining information on the medical examination report for commercial driver fitness determination and all its supporting forms and documentation. Medical examiners certificate mcsa5876, a short form usually referred to as the department of transportation dot card. Division of motor vehicles west virginia department of. Form search results west virginia department of transportation. Before we issue the medical examination report that you. This means that a commercial driver who is renewing or obtaining a new medical certificate on or after may 21, 2014, must be examined by a medical professional listed on the national registry. Driver s information driver completes this section driver s name last, first, middle social. Medical examination report for commercial driver fitness determination. Abnormal findings on physical exam may require further testing such as pulmonary tests.
Your practitioner will complete your medical examination report for commercial driver fitness determination form, provide a summary, a receipt and a medical examiners certificate, as appropriate. Gr protein blood sugar other testing describe and record physical examination. You must pass all dot physical requirements in order to be cleared for your cdl medical card. Your practitioner will complete your medical examination report for commercial driver fitness determination form, provide a summary, a receipt and a medical examiners certificate, as.
Medical certification requirement frequently asked questions. Birthdate m d y age sex m f new certification recertification followup date of exam address city, state, zip code work tel. Keep your drivers dot physicals up to date and your trucks on the road with. Birthdate m d y age sex m f new certification recertification followup date of exam. Medical examiners must complete training and pass a certification examination required by the federal motor carrier safety administration to become. Dec 17, 2019 driver medical fitness for duty drivers are critical to highway safety. Some of the main types of drivers include the following. Medical examination reports must meet the requirements of 391.
Drivers information driver completes this section drivers name last, first, middle social security no. Drivers information driver completes this section date of exam m recertification m d y drivers name last, first, middle social security no. A medical examination report form, mcsa5875, 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. Driver s information driver completes this section driver s name last, first, middle social security no. This medical examination report must remain on file with the department. Having been examined and approved by a cardiologist for medical fitness to drive. Update on commercial driver medical examination rules and.
We will complete your medical examination report for commercial driver fitness determination form and a medical examiners certificate as appropriate. Schedule a dot physical to get your medical examiners certificate. We help you meet documentary compliance requirements mandated by the department of transportation pertaining to commercial drivers. The demands of a commercial driving job can take a toll on your body and your health, so the department of transportation created a standardized test to keep you, and others on the road, safe. Cdl truck drivers, noncdl truck drivers, mta bus drivers. Form mcsa5876 for all qualified drivers including commercial. Medical examination report for commercial driver fitness. Once the examination for a dot health card is complete, our clinicians will fill out the medical examination report for commercial driver fitness determination. If you pass the dot physical, we issue your medical examiners certificate on the spot. For commercial motor vehicle cmv drivers, the most important safety feature is you the driver. Visit us at the miami dot exams for appointments and physical exam with our dot certified doctor. Lung disease, emphysema, asthma, chronic bronchitis. Your medical examination report for commercial driver fitness determination will be send electronically to the commercial drivers license information system cdlis, along with your dot physical forms. A final update regarding posting and use of driver examination forms was published in the federal register allowing mes to use both the current and newly revised versions of the medical examination report form and medical examiners.
The purpose of this examination is to determine a drivers physical qualification to operate a commercial motor vehicle cmv in interstate commerce according to the requirements in 49 cfr 391. We will complete the medical examination report for commercial driver fitness determination form and supporting documents, including dot physical forms. Commercial driver license medical exam visit us at the miami dot exams for appointments and physical exam with our dotcertified doctor. Also known as the dot physical, the point of the physical is to determine your fitness to perform your job. Headbrain injuries, disorders or illnesses seizures, epilepsy medication. Commercial driver license medical eligibility california. Each time you turn the key, you are responsible for your own safety, as well as the safety of all the people who share the road with you. Motor carriers should know that violations related to the driver fitness basic adversely affect sms results for 24 months. Free download medical examination report for commercial driver fitness determination pdf, 322kb and customize with our editable templates, waivers and forms for your needs. Medical examination report for commercial driver fitness determination 649f 6045 1. If a driver fails or is not recertified for a dot medical.
The driver is required to obtain a new phys ical examination and a new medical examination report. Medical examination report for commercial driver fitness determination the drivers role responsibilities, work schedules, physical and emotional demands, and lifestyles among commercial drivers vary by the type of driving that they do. The driver is required to obtain a new phys ical examination and a new medical examination report form, mcsa5875. We perform the dmv eye examination and dot required urine test onsite takes 2 minutes. All dot physical requirements need to be in place in order for you to pass your physical and obtain the cdl medical card. The examiner will then fill out the medical examination report for commercial driver fitness determination form, along with all supporting documents. You will be able to take the completed documents with you. Commercial driver license medical exam in hialeah visit us at the miami dot exams for appointments and physical exam with our dot certified doctor. You will need to carry a copy of this certificate with you when operating a commercial motor vehicle. All dot physical requirements need to be in place in order for you to pass your physical and obtain the cdl medical. Commercial driver license medical exam before we issue the medical examination report that you need, we put you through driver fitness determination tests that include a series of medical exams. Medical examination report for commercial driver fitness determination concentra medical centers ssn.
As part of the physical, drivers are required to fill out the medical. Sleep apnea evaluation of commercial motor vehicle operators. If you pass the dot physical, your dot physical provider will fill out the medical examiners certificate and give you a copy. A cdl physical is the medical exam required to obtain your commercial driver s license. Trusted commercial driver fitness determination specialist serving somerset, nj. Health history driver completes this section, but medical examiner is encouraged to discuss with driver. Texas department of public safety courtesy, service. A driver is asked to fill out a form called a medical examination report for commercial driver fitness determination, also known as the long form which details the driver s medical history. Nyc department of education office of pupil transportation medical examination.
We agree that the using objective criteria is certainly a vast improvement over the selfreported question on the commercial driver medical examination report form. To record results of a drivers physical examination, to determine qualification to operate a. Medical examination report mer form, mcsa5875 fmcsa. Medical examination report for commercial driver fitness determination 1. Nov 26, 2018 the federal motor carrier safety administration requires that interstate commercial motor vehicle drivers maintain a current medical examiners certificate mec, form mcsa5876 to drive. If the form is available in electronic format, click on name of the form to open. The federal motor carrier safety administration requires that interstate commercial motor vehicle drivers maintain a current medical. Driver s name first, last, middle social security no. The card is issued by a dot medical examiner after a dot physical examination. A driver is asked to fill out a form called a medical examination report for commercial driver fitness determination, also known as the long form which details the drivers medical history and lists all current medications. Aug 28, 20 it is a comprehensive assessment of the driver s health history, vision, hearing, blood pressure, lab results, physical examination and more.
Physicians do have some latitude regarding drivers and blood pressure, for example to rule out. Abnormal chest wall expansion, abnormal respiratory rate, abnormal breath sounds including wheezes or alveolar rales, impaired respiratory function, cyanosis. Driver s information driver s name last, first, middle social security no. A medical examiner on the national registry will need to complete the fmcsa medical examination report for commercial driver fitness determination as well as the certificate at the end of the packet. In recording distance vision, use 20 feet as normal. The commercial motor vehicle driver medical examination aims to ensure that commercial drivers can safely perform all driving and nondriving workrelated tasks. Drivers information driver must complete this section. Dot medical examination report for commercial driver fitness determination. We help you meet documentary compliance requirements mandated by the department of transportation pertaining to commercial drivers license eligibility.
The dot exam cmv driver medical fitness examination we appreciate the opportunity to partner with you to provide your medical fitness evaluation. Dot physical onpoint urgent care of aurora, highlands. Medical examination report form for commercial driver medical. Wv commerical driver licensee cdl medical selfcertification affidavit.
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