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Click ‘Get Form’ to open the 1200a department med form in the editor.
In Section I, enter your personal information. This includes your name, signature, social security number, date of birth, home and mailing addresses, as well as your home and business telephone numbers.
Proceed to Section II, where you will provide reasons for your exemption. Carefully respond to each question listed in this section.
Once all sections are completed, review the form for accuracy. Ensure that all required fields are filled out correctly.
Submit the completed form by returning it to Fieldprint, Inc. at the specified address. Remember to keep a copy for your records.

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Do I have to give my employer my long form dot physical?

Answer: Although the FMCSRs do not require the Medical Examiner to give a copy of the Medical Examination Report to the employer, the FMCSA does not prohibit employers from obtaining copies of the medical examination form (long form).

What is a dot medical long form?

The Long Form is your DOT Medical Certificate that shows all the technical information about where you got your DOT medical,who was the doctor/physician that signed off on it,and it also includes yes and no questions regarding any health issues that you may have or have had,including blood pressure,allergies,vision

What is a MCSA 5876 form?

As part of the physical, drivers are required to fill out the medical history portion of the Medical Examination Report (MER) Form, MCSA-5875.

How can I get a copy of my dot long form?

You must contact the Medical Examiner that conducted your evaluation for a copy of your medical certification examination (Long Form).

What does a dot medical card stand for?

A U.S. Department of Transportation (DOT) physical is a medical exam that verifies you meet certain standards to drive a commercial motor vehicle (CMV). Examples of CMVs include semi-trucks, buses and vehicles carrying hazardous materials. Driving these vehicles is a big responsibility.

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