Close
Medical Examination Report Form
Helps you comply with 49 CFR §391.43 DOT medical card requirements. Read more.
Product Code: 47375
Best Selling Driver Qualification Forms
Medical Examination Certificate - Laminated
Helps you comply with 49 CFR §391.43 DOT medical card requirements.
(15)
Medical Examination Certificate - Small
Helps you comply with 49 CFR §391.43 DOT medical card requirements.
(1)
Medical Examination Report Form
Helps you comply with 49 CFR §391.43 DOT medical card requirements.
(2)
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
- Both the Medical Examination Form and Medical Examination Certificate are required by the DOT
- This DOT medical examination form is 9 pages long
- Contains applicable regulations, instructions to the medical examiner, and the form itself
- Measures 8-1/2" x 11”
Volume Pricing
| Product Code | Description | 1 - 9 | 10 - 49 | 50 - 99 | 100 - 249 | 250 - 499 |
|---|---|---|---|---|---|---|
|
47375
|
Medical Examination Form Only
|
$7.24
|
$4.65
|
$2.62
|
$2.30
|
$2.04
|
Specification
| Product Code | Description | Format | Need to Purchase a Case? | Size | Number of Plies |
|---|---|---|---|---|---|
|
47375
|
Medical Examination Form Only
|
Sheet
|
500 per case
|
8.5" x 11"
|
1
|
;){kind=link}