Camp medication form 2025

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Fill in all the blanks on the form that apply to you. List all medications and the physician(s) who prescribed them. Include any vitamins, herbal supplements, or over-the-counter medicines. Write neatly so that others can read your form.
The 391.41 CMV Driver Medication Form, MCSA-5895, requests additional information regarding medications prescribed by the treating physician as an optional tool for Medical Examiners to use in determining if a driver is medically qualified under 49 CFR 391.41.
Examples of prohibited prescription drugs for CDL drivers include opioids and benzodiazepines like , Xanax, and Klonopin. CDL drivers must recognize that a medication, even if legally prescribed, may still not be allowed for use while operating a CMV.
Instructions: This form is to be used by participating physicians and providers to obtain coverage for a formulary drug requiring prior authorization (PA), a non-formulary drug for which there is no suitable alternative available, or any overrides of pharmacy management procedures such as step therapy, quantity limit
Many different medications are taken orally (by mouth). They come as solid tablets, capsules, chewable tablets or orally disintegrating tablets to be swallowed whole or or as a liquid in the form of drops, syrups or solutions.
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A camp registration form is used by summer camps and winter camps to collect information from parents or guardians about their childs attendance.
A CDL driver who has a valid prescription for a non-schedule I medication may not be disqualified if the doctor declares that the medication will not impair their ability to operate a CMV (however, a medical examiner can overrule the prescribing physician and still disqualify the driver).

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