Beginning December 22, 2015 this form may be used in accordance with 49 CFR §391.43. On December 21, 2015, the FMCSA announced a 120-day grace period during which Medical Examiners can use either the current form or this newly revised version.
This form is the December 2015 version that the FMCSA released after the October 2015 version was made available. Please note that the FMCSA could potentially make additional revisions to this form so we recommend that you order based on your current need.
- Complies with Final Rule published April 23, 2015
- Helps you comply with 49 CFR §391.43
- Self-laminating; front laminate protects the driver copy
- Two plies
- Overall measurement 3-1/2" x 7-1/8", Certificate detached 3-1/2" x 6-1/2"
- Folded measurement 3-1/2" x 2-3/16"
- Both the Medical Examination Report and Medical Examination Certificate/DOT Medical Card are required by the DOT
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