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Get FMCSA Medical Examiner's Certificate

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 attachment embodies my findings completely and correctly and is on file in my office. 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. 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. 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 attachment embodies my findings completely and correctly and is on file in my office. A complete examination form with any attachment embodies my findings completely and correctly and is on file in my office. SIGNATURE OF MEDICAL EXAMINER TELEPHONE MD DATE DO Physician Assistant Chiropractor Advanced Practice Nurse DRIVER S LICENSE NO. 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 attachment embodies my findings completely and correctly and is on file in my office. 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 attachment embodies my findings completely and correctly and is on file in my office. SIGNATURE OF MEDICAL EXAMINER TELEPHONE MD DATE DO Physician Assistant Chiropractor Advanced Practice Nurse DRIVER S LICENSE NO. .

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