Medical Examination Report, Certificate, & National Registry Verification

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

Product Code:47999
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Regulatory Alert: Effective April 1, 2025
The FMCSA has reissued its Medical Examiner’s Certificate and Medical Examination Report Form with a new OMB expiration date of “3/31/2028” in the upper right corner and a revision (rev) date of “3/27/25” in the lower right corner. The FMCSA is allowing medical examiners to use up their existing stock of older forms. FMCSA is encouraging, but not requiring, state licensing agencies to continue accepting them. However, motor carriers and medical examiners are advised to switch to the new forms as soon as possible.

Product Information
  • 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)
    • 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
    • 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
    • Measures 8-1/2" x 11-3/4"

View Samples

View a sample Medical Examination Report.

View a sample Medical Examination Certificate - Laminated.

View a sample Medical Examiner's National Registry Verification.

Size: 6" x 10.5"

Need to Purchase a Case?: 150 per case

Average Rating: 5.0

BVNumberOfReviews: 1

UNSPSC Number: Blank certificates - 60101602

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Country Of Origin: USA