Follow the steps to complete the form correctly.

1. Press the ‘Get Form’ button to access the document and open it for editing.
2. Begin by filling in the driver's information. Enter the date of the exam, the driver's full name (last, first, middle), birth date, social security number, telephone number, age, and sex. Indicate whether this form is for a new certification or a follow-up and specify the driver’s license class.
3. Provide the driver’s state of issue and complete the address fields, including city, state, and ZIP code.
4. Navigate to the health history section. The driver should answer whether they have had any illness or injury in the last five years, including specific conditions. For any 'yes' answers, details regarding medications, onset date, diagnosis, treating physician’s name and address, and current limitations should be provided.
5. Instruct the driver to confirm the accuracy of the information provided. They must sign and date the section acknowledging understanding of the examination's implications and authorize the release of their medical records.
6. Medical examiners will complete the following sections regarding vision, hearing, blood pressure, and other health assessments. Specific numerical readings are required for visual acuity and any audiometric testing performed.
7. Fill out the laboratory and other testing findings, including urinalysis results and any additional testing that may have been conducted.
8. Complete the physical examination section, providing numerical readings for height, weight, blood pressure, and any notable findings across various body systems.
9. Review the comments section for any abnormalities observed during the exam and ensure they are clearly documented.
10. After ensuring all sections are filled accurately, users can save changes, download, print, or share the completed form as necessary.

Complete your document online today to ensure your compliance and readiness for the commercial driver's fitness determination.