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Maine driver medical evaluation

Bureau of Motor Vehicles - DRIVER MEDICAL EVALUATION 2026

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The document is a Driver Medical Evaluation form from the Bureau of Motor Vehicles in Maine, designed to assess a driver's physical, emotional, or mental conditions that may impact their ability to operate a vehicle safely. It includes sections for personal information, medical professional evaluations, diagnosis details, and medication history. The form emphasizes the importance of clinician input in determining driver eligibility and provides contact information for further assistance.

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Begin by filling out your personal information in the 'THIS SECTION TO BE COMPLETED BY DRIVER' section. Include your name, date of birth, address, license/history number, and telephone number.
Next, the appropriate medical or paramedical professional should complete the 'INFORMATION BELOW TO BE COMPLETED BY APPROPRIATE MEDICAL OR PARAMEDICAL PROFESSIONAL' section. This includes providing a reason for the report and any relevant functional ability profiles.
In the 'DIAGNOSIS' section, ensure that all required fields are filled out accurately. Check one box per diagnosis and provide additional details as necessary.
Clinicians should document any recommendations regarding restrictions or road tests in the 'CLINICIAN COMMENTS' section. Attach any additional documentation if needed.
Finally, ensure that the clinician's signature and contact information are provided in the 'CERTIFICATE OF EXAMINATION' section before submitting the form.

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Versions	Form popularity	Fillable & printable
2023	4.3 Satisfied (27 Votes)
2009	4 Satisfied (58 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is included in the medical examination report?

A structured format incorporating elements of background information, medical history, physical examination, specimens obtained, treatment provided and opinion is suggested.

What is a dot medical examination report?

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.

What does dot stand for in the medical field?

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.

How to submit a new medical card in NY DMV?

Contact Contact us by email: dmv.sm.cdlmedcertunit@dmv.ny.gov. Mailing Address: Medical Certification Unit. PO Box 2601. Albany, NY 12220-0601. Contact us by fax: 518-486-4421 or 518-486-3260.

What is a BMV check?

0:00 1:48 Or take your driving. Test not exactly the place to dig up your past is it.MoreOr take your driving. Test not exactly the place to dig up your past is it.

driver medical evaluation form maine

Department of driver Services Georgia Department of driver Services Georgia driver's license check DDS Online Services Department of driver Services near me Free Georgia driver's license check GA DMV online Georgia DMV phone number

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How do I docHub my dot medical card?

How to get a DOT medical certification Contact an approved medical provider. The DOT requires drivers to complete their physical exams through an approved provider. Take the DOT physical examination. Submit your DOT medical card. Follow renewal guidelines.