Close
-
-
Medical Examination Certificate - LaminatedHelps you comply with 49 CFR §391.43 DOT medical card requirements.
(12)
-
Medical Examination Certificate - SmallHelps you comply with 49 CFR §391.43 DOT medical card requirements.
(1)
-
Medical Examination Report FormHelps you comply with 49 CFR §391.43 DOT medical card requirements.
(1)
-
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
- Snap out format
- Two plies
- Carbonless
- Measures 8-1/2" x 11-3/4"
Volume Pricing
| Product Code | Description | 100 - 199 | 200 - 299 | 300 - 499 | 500 - 999 | 1000 - 1999 |
|---|---|---|---|---|---|---|
|
27034
|
Snap-Out Format
|
$0.46261
|
$0.3469
|
$0.27744
|
$0.23101
|
$0.20382
|
Specification
| Product Code | Description | Carbon Type | Size | Number of Plies | Units Per Case | Format |
|---|---|---|---|---|---|---|
|
27034
|
Snap-Out Format
|
Carbonless
|
8.5" x 11.75"
|
2
|
2,000 per case
|
Snap-out
|
;){kind=link}