Dot medical examination report for commercial driver fitness determination

The examiner will then fill out the medical examination report for commercial driver fitness determination form, along with all supporting documents. Skill performance evaluation certificate application renewal package. 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. Driver s name first, last, middle social security no. Department of transportation federal motor carrier safety administration public burden statement. Cdl truck drivers, noncdl truck drivers, mta bus drivers. 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. The dot exam cmv driver medical fitness examination we appreciate the opportunity to partner with you to provide your medical fitness evaluation. Driver medical fitness for duty drivers are critical to highway safety.

Also known as the dot physical, the point of the physical is to determine your fitness to perform your job. 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. The card is issued by a dot medical examiner after a dot physical examination. Drivers information driver must complete this section. If you need, we can fax the dot physical form and certificate to your company. You will need to carry a copy of this certificate with you when operating a commercial motor vehicle. 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.

Health history driver completes this section, but medical examiner is encouraged to discuss with driver. Kentucky transportation cabinet division of driver licensing tc 94 35 rev. In recording distance vision, use 20 feet as normal. The federal motor carrier safety administration requires that interstate commercial motor vehicle drivers maintain a current medical. 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. Medical examiners must complete training and pass a certification examination required by the federal motor carrier safety administration to become. Medical examination report for commercial driver fitness determination. We agree that the using objective criteria is certainly a vast improvement over the selfreported question on the commercial driver medical examination report form. Gr protein blood sugar other testing describe and record physical examination. Commercial driver license medical eligibility california.

We perform the dmv eye examination and dot required urine test onsite takes 2 minutes. You must pass all dot physical requirements in order to be cleared for your cdl medical card. We help you meet documentary compliance requirements mandated by the department of transportation pertaining to commercial drivers license eligibility. 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. Commercial driver fitness determination specialist somerset. The commercial motor vehicle driver medical examination. School bus driver physicals medical examination report of driver under article 19a. Drivers information driver completes this section drivers name last, first, middle social security no. About the medical examination report mer form, mcsa5875.

A cdl physical is the medical exam required to obtain your commercial driver s license. Skill performance evaluation certificate application new driver application package. Trusted commercial driver fitness determination specialist serving somerset, nj. Texas department of public safety courtesy, service. The summary of your visit can be sent to your primary care provider with your permission. Free download medical examination report for commercial driver fitness determination pdf, 322kb and customize with our editable templates, waivers and forms for your needs. Health history for any yes answer, indicate onset date, diagnosis, treating physicians name and. Medical certification requirement frequently asked questions.

If the form is available in electronic format, click on name of the form to open. Keep your drivers dot physicals up to date and your trucks on the road with. Dec 17, 2019 driver medical fitness for duty drivers are critical to highway safety. Commercial driver license medical exam in hialeah visit us at the miami dot exams for appointments and physical exam with our dot certified doctor. Our staff will complete the remaining information on the medical examination report for commercial driver fitness determination and all its supporting forms and documentation. Requirements the federal diabetes and vision driver. Commercial motor vehicle cmv driver medical examination results form mcsa5850, an electronic form examiners complete through the national registry website to report exam. Cdl truck drivers, non cdl truck drivers, mta bus drivers. Drivers information driver completes this section date of exam m recertification m d y drivers name last, first, middle social security no. The purpose of this examination is to determine a drivers physical qualification to operate a commercial motor vehicle.

Medical examination report for commercial driver fitness determination concentra medical centers ssn. Dot physical onpoint urgent care of aurora, highlands ranch. Form mcsa5876 for all qualified drivers including commercial. Dot medical examination report for commercial driver fitness determination. Dot medical examination formscertificate download dot. Drivers information drivers name last, first, middle social security no. Visit us at the miami dot exams for appointments and physical exam with our dot certified doctor. 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. Me determines if driver meets physical qualification standards.

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. We help you meet documentary compliance requirements mandated by the department of transportation pertaining to commercial drivers. Having been examined and approved by a cardiologist for medical fitness to drive. Aug 28, 20 it is a comprehensive assessment of the driver s health history, vision, hearing, blood pressure, lab results, physical examination and more.

Wv commerical driver licensee cdl medical selfcertification affidavit. Commercial driver license medical exam visit us at the miami dot exams for appointments and physical exam with our dotcertified doctor. Division of motor vehicles west virginia department of. You will be able to take the completed documents with you. Driver s information driver completes this section driver s name last, first, middle social security no. As part of the physical, drivers are required to fill out the medical history portion of the medical examination report mer form, mcsa5875. Contact us at 7326596650 or visit us at 1527 route 27, suite 2100, somerset, nj 08873. Medical examination report for commercial driver fitness determination merform, mcsa5875, long form. We will complete the medical examination report for commercial driver fitness determination form and supporting documents, including dot physical forms. 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. Selfcertification and valid medical certificates help prevent medically unqualified drivers from operating commercial vehicles. Medical examination reports must meet the requirements of 391. 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.

Walk out with a completed medical examination report for commercial driver fitness determination and a medical examiners certificate. Drivers information driver completes this section date of exam m recertification m d y. All dot physical requirements need to be in place in order for you to pass your physical and obtain the cdl medical card. Motor carriers should know that violations related to the driver fitness basic adversely affect sms results for 24 months. 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. Florida school bus operators medical examination report for. Form search results west virginia department of transportation. Dot physical onpoint urgent care of aurora, highlands. Form popularity medical examination report for commercial driver fitness determination form. Driver s information driver completes this section date of exam m recertification m d y driver s name last, first, middle social security no. Please mail the selfcertification form and medical certificate if. 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. Urine drug testing for new york, ny dot medical examiner. If a driver fails or is not recertified for a dot medical.

The form, mcsa5875, includes a medical examiners certificate mcsa5876 that is signed by a health care professional, when the driver meets the federal requirements. 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. Nyc department of education office of pupil transportation medical examination. 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. Abnormal findings on physical exam may require further testing such as pulmonary tests. Our dot physical is the quickest and most convenient dot medical exam on all of long island nassau, suffolk, queens. As part of the physical, drivers are required to fill out the medical history portion of the medical examination report. To record results of a drivers physical examination, to determine qualification to operate a.

The driver is required to obtain a new phys ical examination and a new medical examination report. If you pass the dot physical, your dot physical provider will fill out the medical examiners certificate and give you a copy. Birthdate m d y age sex m f new certification recertification followup date of exam. Once the examination for a dot health card is complete, our clinicians will fill out the medical examination report for commercial driver fitness determination. Medical examination report for commercial driver fitness determination 1. Medical examiners certificate mcsa5876, a short form usually referred to as the department of transportation dot card. If you pass the dot physical, we issue your medical examiners certificate on the spot. Medical examination report for commercial driver fitness determination 649f 6045 1. Sleep apnea evaluation of commercial motor vehicle operators. Lung disease, emphysema, asthma, chronic bronchitis. For example, if a driver is operating with an expired medical certificate, then he or she is not complying with the driver fitness basic. Medical examination report for commercial driver fitness.

Canvas medical examination report for commercial driver. The driver is required to obtain a new phys ical examination and a new medical examination report form, mcsa5875. Onpoint urgent care also offers dot drug and alcohol testing. 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. Physicians do have some latitude regarding drivers and blood pressure, for example to rule out. Medical examination report for commercial driver fitness determination 2. Medical examination report, dotcertified miami, fl. For commercial motor vehicle cmv drivers, the most important safety feature is you the driver. Abnormal chest wall expansion, abnormal respiratory rate, abnormal breath sounds including wheezes or alveolar rales, impaired respiratory function, cyanosis. The commercial motor vehicle driver medical examination aims to ensure that commercial drivers can safely perform all driving and nondriving workrelated tasks.

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. Driver s information driver s name last, first, middle social security no. Headbrain injuries, disorders or illnesses seizures, epilepsy medication. 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. We will complete your medical examination report for commercial driver fitness determination form and a medical examiners certificate as appropriate. 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. Some of the main types of drivers include the following.

All dot physical requirements need to be in place in order for you to pass your physical and obtain the cdl medical. Medical examination report mer form, mcsa5875 fmcsa. General information federal motor carrier safety regulations advisory criteria. Before we issue the medical examination report that you. 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. Ada information wv dot privacy notices contact us site map disclaimer west virginia code for more information, please call 18006429066 west virginia.

Schedule a dot physical to get your medical examiners certificate. Medical examination report form for commercial driver medical. 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. Update on commercial driver medical examination rules and. Commercial driver fitness determination specialist. This medical examination report must remain on file with the department. Driver s information driver completes this section driver s name last, first, middle social. Dot cdl medical physical examination for commercial driver fitness determination. Birthdate m d y age sex m f new certification recertification followup date of exam address city, state, zip code work tel.