Commercial drivers operating in certain types of commerce are required to obtain a certified medical status and maintain the status to avoid losing their commercial driver license. Medical examination report form mcsa 5875 holland medi. Passing the cdl medical exam is a mandatory step for commercial license applicants in the united states, as drivers must prove they are physically and mentally fit to operate a commercial vehicle. Download d4 form hgv medical examination sheffield. The medical examination report d4 now includes a vision assessment that must be filled in by a doctor or opticianoptometrist. Drivers information driver must complete this section.
Many drivers who file a medical examination report mv3644 or certificate of vision examination by competent authority mv3030v are found to meet medical standards for licensing. There are four commerce types, two of which require a certified medical status. Drivers information driver completes this section date of exam m recertification m d y. Please check the applicants identity before you proceed. Medical examination report for a group 2 lorry or bus licence ref. Commercial driver license selfcertification and medical examiner certificate. D4 medical examination report for a group 2, bus or lorry. Forms and permits publications and reports media center. Special information updates pertaining to all states. Drivers medical examination report dmer province of. The information that will be provided in this document is as follows. Federal motor carrier safety administration fmcsa regulations 49 c.
Medical examination report form primary health medical. About the medical examiners certificate mec, form mcsa5876. A completed medical examination report form d4 must accompany each renewal application. Drivers information driver completes this section drivers name last, first, middle social security no. Medical examination report for commercial driver fitness determination. Medical examination report d4 for a group 2 lorry or bus. Department of transportation federal motor carrier. Medical examination report vision assessment to be filled in by a doctor or opticianoptometrist doctors you must read the notes in the inf4d leaflet so that you can decide whether you are able to fully complete the vision assessment. Driver medical evaluation ds 326 pdf back to main forms. For advice on completing this form, read the leaflet.
Medical examiners certificate mec, form mcsa5876 fmcsa. As a commercial driver license holder, you are required to submit a medical report dated within the last two years, every two years. If you successfully meet the cdl physical exam requirements, you will receive a medical. Send the completed d4 vision and medical assessment with your application form. The complete standards and instructions for conducting this examination are found in section 6. Where can i get a dvla d4 driver medical form from. This order affects all georgia residents and visitors. The federal motor carrier safety administration requires that interstate commercial motor vehicle drivers maintain a current medical examiners. Frequently asked questions about the dvla d4 medical examination.
Under the dvla d4 medical form guidelines this test must be conducted strictly by a medical practitioner who is registered with the general medical council gmc. Submit only the medical doctor or osteopathic physician evaluation page, located at the end of this form. The dvla guidelines state that if you are to drive a commercial vehicle you must be between 6 months and 3 years clear of mental. All cdl holders must selfcertify their medical status in order to renew or upgrade a cdl. As part of the physical, drivers are required to fill out the medical history portion of the medical examination report mer form. The form, mcsa5875, includes a medical examiners certificate mcsa5876 that is signed by a health care professional, when the driver meets the federal requirements. This can be your own gp or a private firm specialising in d4. If the medical examiner determines that the driver examined is physically qualified to drive a commercial motor vehicle in accordance with the physical qualification standards, the medical examiner will complete and provide the driver with a medical examiners certificate mec, form. This document contains statebystate tnstructions for submitting medical certificates for cdl drivers to the state licensing agencies. This is your first application for a provisional group 2 licence. Driver medical doctors local hgvpcv medicals dvla sanctioned. Ambulance c1 medical minibus d1 medical you will also require the medical examination report d4 in the following circumstances. If your physician chooses to use this process, be sure that you complete the form prior to returning it to the driver safety office. Nys dmv mc11a medical certification requirements for commercial driver.
Licenced hgv and pcv drivers are required to report a change in health to the. Alternatively, medical providers with access to the internet can print the dme, complete and sign it, and forward it to the driver. Obtain a commercial drivers license learners permit. Pass a skills test in a vehicle class you intend to operate. Medical examination report d4 north west leicestershire. About the medical examination report mer form, mcsa5875the federal motor carrier safety administration requires that interstate commercial motor vehicle drivers maintain a current medical examiners certificate mec, form mcsa5876 to drive. Medical examination report for a lorry or bus driving. Effective april 20, 2016, examiners are required to use the following updated forms.
Every new driver must undergo an hgv medical exam with accompanying paperwork d4 that is. All clp applicants must selfcertify when conducting their knowledge and skills testing. You will need to carry evidence of a clean medical exam report i. Medical examination report commercial driver medical examination report 649f 6045 medical examination report 414. Driver safety cdl guidelines california department of. The fmcsa has requested that all medical examiners continue providing drivers with a paper copy of the medical examiners certificate form mcsa5876, so that commercial drivers license. A valid original or copy federal mer mcsa5875 form. The federal motor carrier safety administration requires that interstate commercial motor vehicle drivers maintain a current medical examiners certificate mec, form mcsa5876 to drive. Medical examination report mer form, mcsa5875 fmcsa. Medical examination report for commercial driver fitness determination 649f 6045 1. After the age 45, youll need to provide a medical examination report every five years to renew your driving entitlement.
The statewide executive order for reviving a healthy georgia is effective may 14, through may 31. Print medical examination report form print medical examiners certificate. Dot medical examination formscertificate download dot. Physical examination report department of licensing. Medical examination report for a group 2 lorry or bus licence d4 1115 pages 1 and 8 must be completed by the applicant if this form is not fully completed it will be returned and the application will be delayed. If a state accepts mailed in medical certificates, faxed medical certificated, andor emailed medical. Driving licence medical form medical form templates. Medical examination report for a lorry or bus driving licence d4. Check all sections of the medical report have been fully filled in. As of 20 june 2019, dvla no longer accepts medical applications d4 completed by doctors on wheels ltd. To that end, every new driver must undergo an hgv medical exam with. Medical examination report of driver under article 19a.
When are medical examiners mes required to use the newly revised driver examination forms i. Form detail if the form is available in electronic format, click on name of the form to open. The form is clearer and easier to fill in, hopefully less chance of making. Texas department of public safety courtesy, service. Federal guidelines for holding a commercial driver license require you to keep a good driving record and to pass a physical exam every two years. Fmcsrs to require commercial drivers license cdl holders, subject to the physical qualification requirements of the fmcsrs, to provide a current copy of their medical examiners certificate to their state driver licensing agency. The exam must be current within the past 90 days, unless otherwise stated and complete. Submit medical examination report california dmv virtual. Petition for a variance form no id or residency documents. Medical examination report for commercial driver fitness.
Commercial driver medical examination report georgia. Medical examiners are required to complete the medical examination report form for every driver physical examination performed in accordance with 49 cfr 391. Pass a dot physical examination and provide the bmv with an valid medical examination report mer and medical examiners certificate mec. Each original paper or electronic completed medical examination report form must be retained on file at the office of the medical. Wisconsin dmv official government site medical exam. Some doctors will be able to fill in both the vision and medical assessment sections of the report.
Medical applications and forms medical examinations. If you send us an incomplete report your application will be returned. Birthdate m d y age sex m f new certification recertification followup date of exam. If you are aged between 4565 and have been issued a short period licence on medical grounds, with a duration of 1, 2 or 3 years, then you only need to submit a d4. Medical examination report for a group 2 bus or lorry licence.
Medical examination report for commercial driver fitness determination 1. Dvla d4 medical frequently asked questions d4drivers. Before submitting the d4 form, it must first be completed by a qualified doctor, who will undertake a medical examination to report on your medical fitness and. The superintendent will also notify the driver, in writing, of any drivers licence status changes which occur as a result of the information on the report. Physical examination report failure to return this completed form by. Commercial drivers license illinois secretary of state. Insulintreated diabetes mellitus assessment form, mcsa5870. Driver medical frequently asked questions question.
Medical examination report mer form, mcsa5875 federal. New jersey medical examination form medical examination form to be completed by a licensed medical doctor or osteopathic physician. Starting may 21, 2014, all commercial motor vehicle drivers must have a physical performed by a medical examiner listed on the national registry of certified medical. This can be considered as a medical information report. The driving licence medical form set within the dvla guidelines in general contains the same questions to be answered by your medical examiners e.
Medical examination reports must meet the requirements of 391. Any doctor who holds full registration with the gmc general medical council and is licensed to practise medicine in the uk can complete the dvla d4 driver medical. A cdl skills exam must be taken at one of the authorized cdl driving skills exam. Everything you need to know about the hgv medical exam.