Medical Examiners 2 Part Wallet Card and Report

The new expiration date of these forms is 3/31/2025.

The Medical Examiner's 2 Part Certificate Form is required to be carried by every driver of a commercial motor vehicle as proof of medical qualification per 49 CFR 391.41.

MCSA-5876 Medical Examiner's Certificate

This Medical Examiner's Certificate is printed on tri-fold business cardstock. It features a write-able paper top copy. This certificate measures 6"W x 3.5"H unfolded. Once completed it folds down to 3.5" x 2" (business card size) to fit any standard size wallet. This unique MCSA-5876 Medical Examiner's Certificate is 100% driver preferred!

MCSA-5875 Medical Examination Report

Help stay in compliance with the Medical Examination Report. An integral part of the driver qualification file, this form for commercial driver fitness determination contains information required by 49 CFR 391.41. Measures 8.5" x 11".

Our Medical Forms are always up to date with the latest FMCSA Revisions.

This is the official MCSA-5876 Medical Examiner's Certificate and the official MCSA-5875 Medical Examination Reports for all 50 states:

Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin and Wyoming.

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