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Medical Examination Certificate - LaminatedHelps you comply with 49 CFR §391.43 DOT medical card requirements.
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Medical Examination Certificate - SmallHelps you comply with 49 CFR §391.43 DOT medical card requirements.
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Medical Examination Report FormHelps you comply with 49 CFR §391.43 DOT medical card requirements.
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Overview
The Final Rule published April 20, 2012 requires the motor carrier to verify that the medical examiner was qualified to conduct a CDL driver's physical exam. This form meets that requirement.- Helps you comply with DOT's 49 CFR §391.23 and §391.51
- Form can be used now, though it s required to be used as of May 21, 2014
- Includes fields to enter the following information:
- Driver's Name and Identification Number
- Medical Examiner and National Registry Number
- Motor Carrier and Location
- Motor Carrier Representative Signature and Date
- Padded format; 50 sheets per pad
- Single-ply
- Bond white paper
- Measures 8-1/2" x 11"
Volume Pricing
| Product Code | Description | 1 - 2 | 3 - 5 | 6 - 11 | 12 - 999999 |
|---|---|---|---|---|---|
|
27033
|
Book Format - 50 Sheets per Pad
|
$10.99
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$9.17
|
$7.27
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$5.97
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Specification
| Product Code | Description | Units Per Case |
|---|---|---|
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27033
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Book Format - 50 Sheets per Pad
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56 per case
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