CDME Module 1: Overview-Medical Examination Report Form

Pdf Summary

The document is a Medical Examination Report Form (MCSA-5875) for Commercial Driver Medical Certification, provided by the U.S. Department of Transportation Federal Motor Carrier Safety Administration. The form is used to gather information about a driver's medical history, current health conditions, and physical examination results. The driver is required to provide information such as their name, address, date of birth, driver's license number, and current health status. They are also asked to disclose any surgeries, medications they are taking, and answer questions about various health conditions. The driver is required to sign and certify that the information provided is accurate and complete.<br /><br />The form also includes a section for the medical examiner to review the driver's health history and conduct a physical examination. The examiner is required to test the driver's pulse rate, blood pressure, vision, hearing, and conduct a physical examination of various body systems. They are instructed to check for abnormalities and provide detailed comments if any are found.<br /><br />After the examination, the medical examiner is required to determine whether the driver meets the standards outlined in the Federal Motor Carrier Safety Regulations. They can determine that the driver meets the standards, meets the standards but requires periodic monitoring, does not meet the standards, or have a determination pending. The examiner must sign and provide their information on the form, including their medical license, certification, or registration number.<br /><br />The form also includes instructions for completing the form and provides additional information on the purpose of the form and where to find more information.

Asset Caption

(MCSA – 5875)

Keywords

Medical Examination Report Form

MCSA-5875

Commercial Driver Medical Certification

U.S. Department of Transportation

Federal Motor Carrier Safety Administration

driver information

physical examination results

medical examiner

Federal Motor Carrier Safety Regulations

medical license