Jjkeller. com Printed in the United States 651-FS-L2 MEDICAL EXAMINER S CERTIFICATE I certify that I have examined in accordance with the Federal Motor Carrier Safety Regulations 49 CFR 391. SIGNATURE OF MEDICAL EXAMINER TELEPHONE MD DATE DO Physician Assistant Chiropractor Advanced Practice Nurse DRIVER S LICENSE NO. ADDRESS OF DRIVER MEDICAL CERTIFICATE EXPIRATION DATE DISTRIBUTION 1 COPY TO THE DRIVER 1 COPY TO THE MOTOR CARRIER STATE. ALL WRITTEN OR PRINTED INFORMATION MUST BE LEGIBLE Published by J* J* KELLER ASSOCIATES INC. Neenah WI USA 800 327-6868 www. 41-391. 49 and with knowledge of the driving duties I find this person is qualified and if applicable only when wearing corrective lenses driving within an exempt intracity zone 49 CFR 391. 62 wearing hearing aid accompanied by a waiver/exemption qualified by operation of 49 CFR 391. 64 The information I have provided regarding this physical examination is true and complete. A complete examination form with any attach....
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How to fill out the FMCSA Medical Examiner's Certificate online
Filling out the FMCSA Medical Examiner's Certificate is a crucial step for individuals in the transportation industry, ensuring compliance with federal regulations. This guide will provide you with a clear and detailed path to complete the form accurately online.
Follow the steps to successfully complete the form online.
- Press the ‘Get Form’ button to acquire the FMCSA Medical Examiner’s Certificate and open it in the online editor.
- Begin by entering the name of the person who is being examined in the designated field.
- Review the regulations referenced, which are the Federal Motor Carrier Safety Regulations (49 CFR 391.41-391.49), to understand the qualifications required.
- Indicate whether the person being examined requires corrective lenses, a hearing aid, or is accompanied by a waiver/exemption by checking the appropriate boxes.
- The medical examiner should print their name in the provided section clearly.
- Fill out the telephone number of the medical examiner for any necessary follow-up.
- Select the correct professional designation from the options provided (e.g., MD, DO, Physician Assistant, Chiropractor, Advanced Practice Nurse).
- Enter the medical examiner’s license or certificate number along with the issuing state in the designated fields.
- The person being examined should sign in the appropriate section, followed by entering their driver's license number.
- Input the driver’s address accurately, ensuring that all components are legible.
- Finally, indicate the expiration date of the medical certificate in the designated area.
- After completing the form, save your changes, and utilize the options to download, print, or share the completed certificate as needed.
Complete your documents online to streamline your certification process.
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Get answers to your most pressing questions about US Legal Forms API.
What is form MCSA 5876?
If the Medical Examiner determines that the driver examined is physically qualified to drive a commercial motor vehicle in accordance with the physical qualification standards, the Medical Examiner will complete and provide the driver with a Medical Examiner's Certificate (MEC), Form MCSA-5876.
How long is a DOT medical examiner's certificate good for?
About the Exam A DOT physical exam is valid for up to 24 months. The medical examiner may also issue a medical examiner's certificate for less than 24 months when it is desirable to monitor a condition, such as high blood pressure.
Can you get an extension on a DOT physical?
The original FMCSA waiver, set to expire June 30, recognized that state licensing facilities and medical offices that perform DOT physicals may be closed or have restricted hours or staffing, making it difficult or impossible for drivers to renew CDLs or physicals. The waiver is now extended until Sept. 30.
How often do you take a DOT physical?
CDL drivers must take the DOT physical every two years. If you have a condition that needs monitoring, such as high blood pressure, you may be required to get a physical more often. Once you have passed your DOT physical the doctor in charge will give you a certificate.
What do you need to be DOT certified?
To become DOT certified, a driver must undergo a physical exam and a series of safe-driving tests. The U.S. Department of Transportation administers DOT certification. Commercial motor vehicle operators must reapply for DOT certification every two years.
Do employers have to pay for DOT physicals?
Yes, the employer can require you to take a new physical exam, if is company policy. They also usually will pay for the exam if they require it.
Will I lose my CDL if my medical card expires?
If a driver's medical certificate expires before providing a new one, the Department of Revenue will notify the driver that he/she is no longer medically certified to operate a CMV and remove the CDL privileges from the driver's license.
How do you get certified to do DOT physicals?
Register with the NRCME and get your unique identifier number. ... Complete an accredited NRCME Training Course and print your certificate of completion. ... Schedule to sit for the Certification Exam at a Certification Testing Center.
How do I get certified to do DOT physicals?
Register with the NRCME and get your unique identifier number. ... Complete an accredited NRCME Training Course and print your certificate of completion. ... Schedule to sit for the Certification Exam at a Certification Testing Center.
How much does a medical examiner certificate cost?
How Much Does DOT Physical Exam Cost? On MDsave, the cost of DOT Physical Exam ranges from $95 to $140 . Those on high deductible health plans or without insurance can shop, compare prices and save. Read more about how MDsave works.
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