CDME Module 1: Intro and Overview (2025)-Medical Examiner's Certificate Form

Medical Examiner's Certificate Form

Pdf Summary

Form MCSA-5876, or the Medical Examiner’s Certificate, is a document used for Commercial Driver Medical Certification, under the oversight of the U.S. Department of Transportation's Federal Motor Carrier Safety Administration (FMCSA). The form is facilitated in compliance with the Paperwork Reduction Act, indicated by its unique OMB Control Number 2126-0006, valid until March 31, 2025. The estimated public reporting burden for this form is about one minute per response, covering reviewing instructions, data gathering, and completion.<br /><br />The form certifies that a driver has been examined according to the Federal Motor Carrier Safety Regulations (49 CFR 391.41-391.49) and is deemed qualified for commercial driving duties, or with state-specific regulations if applicable. The certifying medical examiner indicates any conditions under which the driver is qualified, such as the use of corrective lenses, hearing aids, or a waiver/exemption.<br /><br />The form includes specific fields for the medical examiner’s certification details, including their name, license number, signature, and National Registry Number. It also requires the driver's details, including driver's license number, issuing state, address, and signature. <br /><br />Critical information about maintaining the confidentiality and proper handling of this document is emphasized, as it contains sensitive personal information. Improper handling could negatively affect individuals, hence the need to keep it secure and under authorized control. Once no longer required to be maintained, proper disposal according to regulatory requirements is mandated.

Keywords

MCSA-5876

Medical Examiner's Certificate

Commercial Driver Medical Certification

FMCSA

Paperwork Reduction Act

OMB Control Number 2126-0006

Federal Motor Carrier Safety Regulations

medical examiner

driver qualifications

confidentiality