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Medical Examination Reports and Certificates
These forms will help you comply with 49 CFR §391.43.
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Overview
Both the Medical Examination Report AND Certificate are required by the DOT.

In the News: Rule merges medical examiner’s certificate and CDL
The Federal Motor Carrier Safety Administration (FMCSA) has issued a final rule merging the medical examiner’s certificate with the commercial driver’s license (CDL). Read more...


The following forms are available:

  • (649-F) Medical Examination Report
    Report is 8 pages long. Contains applicable regulations, instructions to the medical examiner, and the form itself. Measures 11" W x 8-1/2" L.
  • (657-FS -L 2)Medical Examiner's Certificate - Laminated Format
    2-ply. Measures 4-1/4" W x 4-1/2" L.
  • (650-FS -L 2)Medical Examiner's Certificate - Paper Format
    2-ply, carbonless, snap-out format. Measures 4-1/4" W x 6-7/8" L.
  • 651-FS -L 2)Medical Examiner's Certificate - Tent Card
    2-ply, carbonless, snap-out format. Measures 4-1/4" W x 4" L; reduced size folds to finished wallet size format, 2-1/8" W x 3-3/8" L.

To view these forms and hundreds of other J. J. Keller forms, visit the Forms Resource Center.

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