Get State Form # 49867

This guide provides a comprehensive and user-friendly approach to completing the State Form # 49867, which is essential for medical examination reports for commercial driver fitness determination. Follow the instructions carefully to ensure that all required information is accurately submitted online.

Follow the steps to complete your State Form # 49867 online.

1. Click ‘Get Form’ button to obtain the State Form # 49867 and open it in the online editor.
2. Begin filling in the driver’s information section. Include the driver’s name, address, age, social security number, and contact details. Indicate whether this is a new certification, recertification, or follow-up.
3. Complete the health history section. This part requires the driver to answer various questions regarding their medical history. Discuss any 'yes' answers with a medical examiner if necessary.
4. Move to the vision section, where the medical examiner will report on the driver's visual acuity, ensuring to include details on corrective lenses if used.
5. In the hearing section, similar to vision, the medical examiner records the driver's hearing capability, including any hearing aid requirements.
6. Next, document the driver’s blood pressure and pulse. Two readings are required to confirm the accuracy of these measurements.
7. Fill out the laboratory and other test findings section, including urinalysis results and any additional testing as necessary.
8. Lastly, complete the physical examination section with the medical examiner's observations. Ensure any abnormalities are documented clearly, and indicate if the driver qualifies to operate a commercial vehicle.
9. After filling in all sections, review the completed form for accuracy. Save any changes made to the document.
10. Finally, download, print, or share the form as needed to submit it according to the relevant guidelines.

Complete your State Form # 49867 online today to ensure timely submission and compliance.