Medical Examination Report, Certificate, & National Registry Verification – Retail Packaging (011643)
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Medical Examination Report, Certificate, & National Registry Verification – Retail Packaging

These forms will help you comply with 49 CFR §391.43. Read more.

Product Code: 47999
List Price: $7.96
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Overview

NOTICE: The latest Medical Examiner’s Certificates show an OMB expiration date of 11/30/2021 in the upper-right corner. On Dec. 4, 2018, the Federal Motor Carrier Safety Administration (FMCSA) informed us that there is no specific deadline when forms dated 8/31/2018 or 9/30/2019 can no longer be used, though they do “suggest” that the 2019 or 2021 versions be used in place of the 2018 version. The FMCSA also announced that it “is encouraging the State Driver's Licensing Agencies (SDLAs) to accept these forms with expiration dates of 08/31/2018, 09/30/2019, and 11/30/2021.” Therefore, all three versions remain acceptable but upgrading to the 2019 or 2021 versions is advised.


  • Helps you comply with 49 CFR §391.43
  • The Medical Examination Report, Medical Examination Certificate/DOT Medical Card, and the Medical Examiner’s National Registry Verification are required by the DOT
  • Medical Examination Report - 47375 (761-F)
    • Complies with Final Rule published April 23, 2015
    • Helps you comply with 49 CFR §391.43
    • 9 pages long
    • Contains applicable regulations, instructions to the medical examiner, and the form itself
    • Measures 8-1/2" x 11"
  • Medical Examiner's Certificate - Laminated Paper Format (DOT Medical Card) - 47379
    • Complies with Final Rule published April 23, 2015
    • Helps you comply with 49 CFR §391.43
    • Self-laminating; front laminate protects the driver copy
    • 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"
  • Medical Examiner’s National Registry Verification – 27034 (758-FS-C2)
    • Snap out format
    • Two plies
    • Carbonless
    • Complies with DOT's 49 CFR §391.23 and §391.51
    • Required to be used as of May 21, 2014
    • Measures 8-1/2" x 11-3/4"

Volume Pricing

Volume Pricing
Product Code Description 1 - 9 10 - 149 150 - 999999
47999
(1) Report, (1) Certificate, & (1) Verification Form
$7.96
$6.60
$5.93

Specification

Specification
Product Code Description Size Need to Purchase a Case?
47999
(1) Report, (1) Certificate, & (1) Verification Form
6" x 10.5"
150 per case

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