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Form MCSA5876 (Revised: 12/06/2015) OMB No

2015) OMB No-2025

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The document is Form MCSA-5876, a Medical Examiner's Certificate used for Commercial Driver Medical Certification by the U.S. Department of Transportation's Federal Motor Carrier Safety Administration. It outlines the requirements for medical examinations of commercial drivers, including necessary qualifications and exemptions. The form includes sections for the medical examiner's details, driver's information, and certification of the examination results.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the driver's last and first name in the designated fields. Ensure accuracy as this information is crucial for identification.
Select the appropriate certification option by checking one of the boxes that correspond to the Federal Motor Carrier Safety Regulations. This section determines the qualifications based on your medical examination.
If applicable, check any additional qualifications such as wearing corrective lenses or having a waiver/exemption. This ensures all necessary conditions are documented.
The medical examiner must sign and provide their details, including their license number and issuing state. Make sure this section is completed accurately to validate the examination.
Finally, have the driver sign and fill in their driver's license number and address. Review all entries for completeness before submitting.

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How long must a medical examiner retain a copy of the medical examination report for a qualified driver?

Each original (paper or electronic) completed Medical Examination Report Form must be retained on file at the office of the medical examiner for at least 3 years from the date of examination.

How can I get a copy of my medical examiners certificate?

Answer: You can contact the Medical Examiner that conducted your evaluation for a copy of your medical certification examination.

What happens if I lost my dot medical card?

A copy of the Medical Examiners Certificate should be kept on file in the Medical Examiners office. The driver may request a replacement copy of the medical card from the Medical Examiner or get a copy of the certificate from the motor carrier.

What is a MCSA 5875 form?

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

What is a MCSA form?

If the Medical Examiner determines that the driver examined is physically qualified to drive a commercial motor vehicle in ance with the physical qualification standards, the Medical Examiner will complete and provide the driver with a Medical Examiners Certificate (MEC), Form MCSA-5876.

How to get a new dot card?

If a DOT certificate is expiring, a driver must have a new DOT physical examination and obtain a new DOT medical examiners certificate. The certificate must then be submitted to the DMV.

How do I get a copy of my dot number?

Answer: Online: Go to the SAFER website and search by name, USDOT number or MC number. Submit a ticket: Visit our website at: ask.fmcsa.dot.gov. Chat: Initiate a live chat with FMCSA Customer Service. Phone: Call 800-832-5660 to speak to FMCSA Customer Service.

How to get USDOT medical examiners certificate?

How to get a DOT medical certification Contact an approved medical provider. Take the DOT physical examination. Submit your DOT medical card. Follow renewal guidelines. Fulfills job requirements. Reduces liabilities. Provides career opportunities. Who needs a DOT medical certification?

Form MCSA5876 (Revised: 12/06/2015) OMB No-2025

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How to use or fill out Form MCSA5876 (Revised: 12/06/2015) OMB No with our platform

Complete this form in 5 minutes or less

Got questions?

How long must a medical examiner retain a copy of the medical examination report for a qualified driver?

How can I get a copy of my medical examiners certificate?

What happens if I lost my dot medical card?

What is a MCSA 5875 form?

What is a MCSA form?

People also ask

How to get a new dot card?

How do I get a copy of my dot number?

How to get USDOT medical examiners certificate?

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Form MCSA5876 (Revised: 12/06/2015) OMB No-2025

Here's how it works

How to use or fill out Form MCSA5876 (Revised: 12/06/2015) OMB No with our platform

Complete this form in 5 minutes or less

Got questions?

How long must a medical examiner retain a copy of the medical examination report for a qualified driver?

How can I get a copy of my medical examiners certificate?

What happens if I lost my dot medical card?

What is a MCSA 5875 form?

What is a MCSA form?

Related Searches

People also ask

How to get a new dot card?

How do I get a copy of my dot number?

How to get USDOT medical examiners certificate?

Related links

Try more PDF tools