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  • Medical Examination Report (MER) Form, MCSA-5875 | FMCSA
    As part of the physical, drivers are required to fill out the medical history portion of the Medical Examination Report (MER) Form, MCSA-5875
  • Medical Examination Report - California DMV
    Submit a CDL Medical Examination Report Before you begin: As a Commercial Driver’s License (CDL) holder, you are required to submit a medical report dated within the last two years, every two years You are required to submit: A valid (original or copy) federal MER MCSA-5875 form Medical Examiner’s Certificate Form, (MEC) MCSA-5876
  • MCSA-5875 Form - Regulations. gov
    PURPOSE: To record results of a driver's physical examination to determine qualification to operate a commercial motor vehicle (CMV) in interstate commerce according to the require-ments in 49 CFR 391 41-49 Providing this information is mandatory
  • Medical Examination Report Form (MCSA 5875) - v7. 51+#0016
    A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number
  • New DOT Medical Certification Forms: MCSA-5875 MCSA-5876
    PDF Versions of the forms are available at these links on the FMCSA website:
  • FMCSA Form MCSA-5875 - Medical Examination Report Form MCSA-5875 23
    DRIVER HEALTH HISTORY REVIEW discuss pertinent driver answers and any available medical records Comment on the driver's responses to the "health history" questions that may aff (Attach additional sheets if necessary) OMB No : 2126-0006 Expiration Date: 03 31 2025 Form MCSA-5875 Last Name: First Name: DOB: Exam Date:
  • Instructions for Completing the Medical Examination Report Form (MCSA-5875)
    Thus, if you find a disqualifying condition for which a driver may receive a Federal Motor Carrier Safety Administration medical exemption, please record that on the driver’s Medical Examiner’s Certificate, Form MCSA-5876, as well as on the Medical Examination Report Form, MCSA-5875
  • How to Submit Your DOT Physical to California DMV
    After a DOT physical, the medical examiner generates two forms The Medical Examination Report (MER), Form MCSA-5875, is the detailed record of your exam, covering your medical history and the examiner’s findings


















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