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.

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• Complies with Final Rule published April 23, 2015
• Helps you comply with 49 CFR §391.43
• Both the Medical Examination Report and Medical Examination Certificate are required by the DOT
• This DOT medical examination report is 9 pages long
• Contains applicable regulations, instructions to the medical examiner, and the form itself
• Measures 8-1/2" x 11”