CDME Module 1: Intro and Overview (2025)-Medical Examination Report Form

Medical Examination Report Form

Pdf Summary

The document is a Medical Examination Report Form (MCSA-5875) used for certifying commercial drivers in accordance with Federal Motor Carrier Safety Regulations. It requires drivers to provide personal information, health history, and other relevant medical details necessary for their certification. The form, managed by the U.S. Department of Transportation and the Federal Motor Carrier Safety Administration, has a valid OMB Control Number (2126-0006) until 03/31/2025.<br /><br />The form begins with a public burden statement clarifying that filling the form, estimated to take 25 minutes, is mandatory and protected under the Paperwork Reduction Act. Failure to have a valid OMB number means one isn’t obligated to comply. Driver information includes basic details like name, date of birth, license number, and health queries ranging from surgeries to medications and chronic health issues.<br /><br />The form inquires about prior medical certificate denials, surgeries, medications, and various health conditions through a checklist approach with a "yes," "no," or "not sure" response requirement. The driver must certify the truthfulness of the provided information, understanding the implications of false submissions.<br /><br />A medical examination, overseen by a qualified medical examiner, includes reviews of driver health history, vision and hearing tests, urinalysis, blood pressure checks, and physical exams assessing various body systems. The examination aims to ensure that the driver meets standards stipulated under Title 49 Code of Federal Regulations (CFR) parts 391.41-391.49, either federally or with state variances for intrastate operations.<br /><br />The medical examiner notes findings and issues a qualification determination, which might include conditions like wearing corrective lenses or periodic health monitoring. The process intends to affirm that a driver can safely operate a commercial motor vehicle while complying with FMCSA regulations.

Keywords

Medical Examination Report

MCSA-5875

commercial drivers

Federal Motor Carrier Safety Regulations

health history

U.S. Department of Transportation

Paperwork Reduction Act

medical examiner

Title 49 CFR

FMCSA regulations