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Medical Examiners 2 Part Wallet Card and Report

Medical Examiners 2 Part Wallet Card and Report

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Price: $0.80

Includes DOT Medical Examination Report and 2-Part Medical Wallet Card for CDL Commercial Truck Drivers Qualification Folders, includes new DOT revisions.

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  Product ID USMEC2LF
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The Expiration Date on these MCSA-5876 and MCSA-5875 forms is 11/30/2021.

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.

The medical examiner's certificate is easy to transport and carry given it's wallet size. The top ply is paper and the bottom ply is premium durable cardstock. This card folds to business card size and fits any standard size wallet.

The Medical Examiners Certificate includes:

  • National Registry Field
  • Signature of Driver
  • Telephone
  • Date Signed
  • Medical Examiners Name
  • Physician Type
  • License Number
  • Registration Number
  • Certificate Number
  • Issuing State
  • Signature of Driver
  • Drivers License Number
  • Issuing State
  • Address of Driver
  • Certificate Expiration Date
  • More

Medical Examiner 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 the following 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
Wyoming.

Questions about revisions? Inquire here.

Quantity pricing applied in cart.

 
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Quantity Pricing
Quantity
Price
25-49
$0.76
50-99
$0.72
100-149
$0.68
150+
$0.64

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