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Medical Examination Certificate (011710)
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Medical Examination Certificate

Helps you comply with 49 CFR §391.43 DOT medical card requirements. Read more.

Regulatory Alert: Effective January 16, 2024, the FMCSA revised its Medical Examiner’s Certificate and Medical Examination Report Form to remove an obsolete reference. Learn More

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Overview

Regulatory Alert: Effective January 16, 2024,
The FMCSA revised its Medical Examiner’s Certificate and Medical Examination Report Form to remove an obsolete reference. The new forms may be identified by a revision (rev) date, respectively, of “3/1/23” and “2/28/2023” in the lower corner (the date in the upper corner remains 3/31/2025). The FMCSA is allowing medical examiners to use up their existing stock of older forms, and is encouraging state licensing agencies to continue accepting them, beyond the January 16 deadline. However, motor carriers and medical examiners are advised to switch to the new forms as soon as possible.

  • Helps you comply with 49 CFR §391.43
  • Laminated or Unlaminated
  • Two plies
  • Tri-fold
  • Overall measurement 3-1/2" x 7-1/8", Certificate detached 3-1/2" x 6-1/2"
  • Folded measurement 3-1/2" x 2-3/16"
  • Both the Medical Examination Report and Medical Examination Certificate/DOT Medical Card are required by the DOT

View Sample

View a sample Medical Examination Certificate - Laminated.

Volume Pricing

Volume Pricing
Product Code Description 1 - 9 10 - 49 50 - 99
Higher quantities available. Pricing reflected in shopping cart or call 1-877-564-2333 to order.
47379
Laminated
$3.01
$2.82
$1.59
67602
Unlaminated
$2.86
$2.68
$1.52

Specification

Specification
Product Code Description Carbon Type Format Number of Plies Size Need to Purchase a Case? Material Country Of Origin
47379
Laminated
Carbon
Snap-out, self-laminating
2
Ply 1 - 3.5" x 7.125", Ply 2 - 3.5" x 7.125"
500 per case
Laminate
USA
67602
Unlaminated
Carbon
Snap-out
2
Ply 1 - 3.5" x 7.125", Ply 2 - 3.5" x 7.125"
500
Unlaminate
USA

View Sample

View a sample Medical Examination Certificate - Laminated.

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