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How to use or fill out Form MCSA5876 (Revised: 12/06/2015) OMB No with our platform
- Click ‘Get Form’ to open it in the editor.
- Begin by entering the driver's last and first name in the designated fields at the top of the form.
- Select the appropriate checkbox to indicate whether the examination was conducted under Federal Motor Carrier Safety Regulations or with applicable State variances.
- If applicable, check any conditions that apply, such as wearing corrective lenses or having a waiver/exemption.
- The medical examiner must then provide their signature, telephone number, and printed name in the specified areas.
- Fill in the expiration date of the Medical Examiner's Certificate and the date when it was signed.
- Complete additional details regarding the medical examiner's credentials, including their state license number and national registry number.
- Finally, have the driver sign and provide their driver's license number along with their address information.
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