Mcsa 5875-2026

The document is the Medical Examination Report Form MCSA-5875, revised on December 2, 2015, used for assessing the medical qualifications of commercial drivers in accordance with federal regulations. It includes sections for driver information, health history, examination results, and determinations by medical examiners. The form is mandatory for drivers seeking certification to operate commercial motor vehicles and outlines the necessary procedures for both drivers and medical examiners, including privacy statements and reporting requirements.

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Click ‘Get Form’ to open the MCSA-5875 in the editor.
Begin with Section 1: Driver Information. Fill in your personal details including last name, first name, date of birth, and address. Ensure accuracy as this information is crucial for your medical certification.
Complete the Driver Health History section by answering questions about past surgeries and current medications. Be honest and thorough; any 'yes' answers will require further explanation.
Sign and date the CMV Driver's Signature section at the end of Section 1, certifying that all provided information is accurate.
If you are a medical examiner, proceed to Section 2: Examination Report. Review the driver’s health history and conduct necessary tests such as blood pressure and vision checks.
Finalize by completing either the Federal or State Medical Examiner Determination section based on your findings.

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