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Medical Examination Report Form (010464)
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Medical Examination Report Form

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: 47375
List Price: $9.05
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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
  • 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

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.
47375
Medical Examination Form Only
$9.05
$5.81
$3.28

Specification

Specification
Product Code Description Format Number of Plies Size Need to Purchase a Case? Country Of Origin
47375
Medical Examination Form Only
Sheet
1
8.5" x 11"
500 per case
USA

View Sample

View a sample Medical Examination Report.

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