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Medical Examination Certificate - Small (011709)
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Medical Examination Certificate - Small

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

Alert: The FMCSA has updated its medical exam forms effective December 15, 2021. See Overview for details.

Product Code: 47377
List Price: $2.05
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Overview

Reg Alert: The FMCSA has updated its medical exam forms effective December 15, 2021. The new versions of its Medical Examination Report Form and Medical Examiner’s Certificate include an OMB expiration date of 12/31/2024 printed in the upper-right corner. The FMCSA announced that medical examiners should transition to the new forms as soon as possible. However, the agency is encouraging state licensing agencies to continue accepting older medical cards from CDL drivers until medical examiners use up their existing stock of the older forms.
  • Helps you comply with 49 CFR §391.43
  • Two plies
  • Measures 4-1/4” x 5-1/4”
  • Both the Medical Examination Report and Medical Examination Certificate/DOT Medical Card are required by the DOT

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.
47377
Small
$2.05
$1.92
$1.02

Specification

Specification
Product Code Description Carbon Type Format Number of Plies Size Need to Purchase a Case? Country Of Origin
47377
Small
Carbonless
Snap-out
2
4.25" x 5.25"
2,300 per case
USA

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