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Medical Examination Report (MER) Form, MCSA-5875

    https://www.fmcsa.dot.gov/regulations/medical/medical-examination-report-form-commercial-driver-medical-certification
    Medical Examination Report Form MCSA-5875.pdf (457.22 KB) About the Medical Examination Report (MER) Form, MCSA-5875: The Federal Motor Carrier …

Medical Examination Report Form Federal Motor …

    https://www.fmcsa.dot.gov/sites/fmcsa.dot.gov/files/2022-03/Medical%20Examination%20Report%20Form%20MCSA-5875.pdf
    MEDICAL RECORD # SECTION 1. Driver Information(to be filled out by the driver) (or sticker) PERSONAL INFORMATION Last Name:First Name:Middle Initial:Date of Birth: …

DOT Medical Exam and Commercial Motor Vehicle …

    https://www.fmcsa.dot.gov/medical/driver-medical-requirements/dot-medical-exam-and-commercial-motor-vehicle-certification
    DOT Medical Exam and Commercial Motor Vehicle Certification About the Exam A Department of Transportation (DOT) physical examination must be conducted …

FMCSA National Registry - Transportation

    https://nationalregistry.fmcsa.dot.gov/home
    1. Register Online Complete the online registration. This is the first step in becoming a certified Medical Examiner. Register 2. Complete Training Contact a training provider to …

Vision Evaluation Report, Form MCSA–5871 | FMCSA

    https://www.fmcsa.dot.gov/regulations/medical/vision-evaluation-report-form-mcsa-5871
    The Medical Examiner must receive a completed Vision Evaluation Report, Form MCSA–5871, that is signed and dated by an ophthalmologist or optometrist before …

DOT Physical Forms and Others to Fill Out Before Your …

    https://www.concentra.com/patients/forms-for-your-visit/
    Employer Authorization Form — We must have a completed and signed Employer Authorization Form for any patient coming to a Concentra Medical Center for treatment …

Insulin-Treated Diabetes Mellitus Assessment Form, …

    https://www.fmcsa.dot.gov/regulations/medical/insulin-treated-diabetes-mellitus-assessment-form-mcsa-5870
    As a part of the medical certification process for insulin treated diabetes mellitus (ITDM) individuals, the Federal Motor Carrier Safety Administration requires that …

Forms | US Department of Transportation

    https://www.transportation.gov/civil-rights/civil-rights-library/forms
    The Forms portion of this library provides access to forms relating to Employees, External (Non-employee), and Disadvantaged Businesses. These forms can …



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