... All medical exams MUST be completed on a form MCSA- 5876. Search the current Agency with a Keyword. Search Department of Motor Vehicles. Free Driver Mobile App! DOT Physical Form. CA DMV Contact Information. As part of the physical, you are required to fill out the medical history portion of the Medical Examination Report of Commercial Driver Fitness Determination. Form MCSA-5875 (Revised: 12/09/2015) OMB No. Current offerings include the use of the Medical Treatment Utilization Schedule (MTUS) and tips for Qualified Medical Evaluators (QME). Didn’t find the form you need?

Should you have more questions about filling out required CA DMV forms, leave us a comment below or can contact the CA DMV at (800) 777-0133. As part of the Motor Carrier Safety Improvement Act, the Federal Motor Carrier Safety Administration (FMCSA) amended the Federal Motor Carrier Safety Regulations (FMCSRs) to require commercial driver’s license (CDL) holders, subject to the physical qualification requirements of the FMCSRs, to provide a current copy of their Medical Examiner’s Certificate to their state driver licensing agency. 2570 24. th Street M/S J-152 . Public Burden Statement Your rights to inspect your examination papers are set forth in Title 2, section 186 -189 of the California Code of Regulations, which can be accessed at Office of Administrative Law website at: oal.ca.gov.
dmvlodmedicalpublications@dmv.ca.gov. Expiration Date: 9/30/2019. 7/2019) Page 2 STATE OF CALIFORNIA - CALIFORNIA DEPARTMENT OF HUMAN RESOURCES EXAMINATION / EMPLOYMENT APPLICATION STD.

Filtered Topic Search. The physical examination should be done carefully and at least as complete as is indicated by the attached form.

You are required to upload your medical certification to: Connecticut's Online Medical Certification System . Licensing Operations Division .
If you received a letter from DMV requesting DMV Medical Evaluation form filled out by physicians to re-instate your drivers license we can help. There is now an approved 44-hour IDE provider for the QME Exam for Chiropractors. Department of Motor Vehicles . DRIVER'S INFORMATION Driver completes this section Date of Exam M Recertification M / D / Y Driver's Name (Last, First, Middle) Social Security No. the DMV from a medical business e- mail account. Medical Examination Report Form (for Commercial Driver Medical Certification) U.S. Department of Transportation Federal Motor Carrier Safety Administration. Email your request to . 903 S. Crenshaw Bl 206A Los Angeles 90019 1-213-507-7530 678 (REV. DWC offers free online education courses providing continuing education credits for physicians, QMEs, chiropractors, and nurses. records. Medical Examination Report Form (for Commercial Driver Medical Certification) U.S. Department of Transportation Federal Motor Carrier Safety Administration. Some forms may only be picked up in person at the nearest CA DMV office. Form MCSA-5875. 2126-0006. Obtain a DL 33 form from your local DMV office or by calling DMV at 1-800-777-0133. For those who would prefer a paper version mailed, please call (916) 657-6550. Completing the form before your appointment will help to obtain your CDL medical card more quickly.

Download the Free TeamCME Mobile Driver App, save your expiration date, and receive an alert starting 2 months before your current medical card expires. OMB No. Public Burden Statement

Birthdate Age Sex New Certification F Follow-up 2126-0006 Expiration Date: 8/31/2018. Medical Examination Report FOR COMMERCIAL DRIVER FITNESS DETERMINATION 649-F (6045) 1. Get "Expiration Alerts" before your medical card expires. NOTE: If your driver education and driver training were taken in a state other than California, DMV will accept either a "To Secondary Schools Other Than California Schools" form (DL 33) form completed by the out-of-state secondary school Ca dmv medical examination form. The Federal Motor Carrier Safety Administration requires that interstate commercial motor vehicle drivers maintain a current Medical Examiner’s Certificate to drive. Sacramento, CA 95818 (916) 657-6550 Commercial Licensing Policy .

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