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FMCSA Medical Exam Form

All DOT/CDL (CMV) drivers are required to fill out SECTION 1 (pages 1 and 2) of the FMCSA Medical Examination Report Form.  This form can be printed and completed by the driver ahead of the office visit, expediting the examination.  

Medical Examination Report Form MCSA-5875
(For Commercial Driver Medical Certification) 
FMCSA Medicl Exam

Medical Clearance Forms

For use by treating medical providers/primary care providers to supply additional information related to a patient's medical condition(s).  This information is necessary to complete DOT/CDL medical examinations for drivers with certain medical conditions.  Use the "Medical DOT Clearance Form" for any medical condition not listed below.

Non-Insulin-Treated Diabetes
Assessment Form MCSA-5872 

Insulin-Treated Diabetes Mellitus Assessment Form MCSA-5870 

Hypertension

DOT Clearance Form

Cardiac

DOT Clearance Form

Diabetes Non-Insulin
Diabetes Insulin
Hypertension
Cardiac

Obstructive Sleep Apnea

DOT Clearance Form

Medical
DOT Clearance Form

Return to Duty / Work

DOT Clearance Form

 391.41 CMV Driver
Medication Form MCSA-5895  

Sleep Apnea
Medical
Return to Work
Driver Medication

Vision Evaluation
Report Form MCSA-5871 

Vision Evaluation
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