Mcsa5875 2026

The document is the Medical Examination Report Form MCSA-5875, revised on April 1, 2013, used by the U.S. Department of Transportation for commercial driver medical certification. It outlines the requirements for medical examiners to assess a driver's physical qualifications to operate a commercial motor vehicle (CMV) in interstate commerce. The form collects personal and health history information from drivers, mandates retention of records for three years, and specifies that all responses are mandatory. It also includes privacy statements and guidelines for handling medical data.

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Click ‘Get Form’ to open the MCSA-5875 in the editor.
Begin by filling out Section 1, which includes your personal information. Enter your last name, first name, middle initial, date of birth, age, gender, address, city, state, zip code, and phone number.
Provide your driver license number and state of issue. Indicate if you are intrastate only and whether you hold a commercial driver's license (CDL).
Answer the health history questions honestly. Each question requires a 'Yes' or 'No' response regarding past medical conditions that may affect your ability to operate a commercial motor vehicle.
In the lifestyle section, indicate your tobacco and alcohol use as well as any illegal substance usage within the past two years.
Finally, sign and date the form at the bottom of Section 1 to confirm that all information provided is accurate.

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