Dot Medical Form

• Dot Medical Forms 2025
• Dot Medical Examiner

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Dot Medical Form

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Dot Medical Form

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The Medical Examiner will keep a copy of the Medical Examiner s Certificate MEC Form MCSA 5876 on file for at least 3 years Last updated Wednesday March 30 2022 About the Medical Examiner s Certificate MEC Form MCSA 5876If the Medical Examiner determines that the driver examined is physically qualified to drive a Medical Examination Report Form (for Commercial Driver Medical Certification) Last Name: Middle Initial: Street Address: Driver’s License Number: . Record what type of photo ID was used to verify the identity of the driver, e.g., CDL, driver’s license, passport. Form MCSA-5875 OMB No.: 2126-0006 Expiration Date: 1 /3 /202 Page 2 Last Name .

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Dot Medical FormAbout the Exam. 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 term includes, but is not limited to, doctors of medicine (MD), doctors of osteopathy (DO), physician assistants. Last updated Wednesday March 30 2022 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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