Medical certification form new driver applicant 2026

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  1. Click ‘Get Form’ to open the medical certification form in our editor.
  2. Begin by entering the applicant's name in the designated field. Ensure that the name matches the identification documents.
  3. Next, input the date of the medical examination. This date must not exceed 90 days prior to your TLC application submission.
  4. The licensed physician will need to complete their section, certifying whether the applicant is medically fit or unfit to operate a TLC licensed vehicle.
  5. Ensure that the physician provides their last name, first name, signature, mailing address, license number, and contact information in the appropriate fields.
  6. Finally, remind the physician to validate this form with an official stamp before submission.

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Directly Observed Therapy. Page 14 of 29. The most effective strategy to ensure adherence to treatment is directly observed therapy (DOT). DOT means that a health care worker or another designated person watches the TB patient swallow each dose of the prescribed drugs.
A structured format incorporating elements of background information, medical history, physical examination, specimens obtained, treatment provided and opinion is suggested.
Medical Examination Report (MER) Form, MCSA-5875 The MER contains the drivers information and health history, as well as the findings of the medical examiner during the DOT exam.

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