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Medical Examination Report FOR COMMERCIAL DRIVER FITNESS DETERMINATION 649-F 6045 1. DRIVER S INFORMATION Driver completes this section Driver s Name Last First Middle Social Security No. Birthdate M/D/Y Address City State Zip Code Work Tel Age New Certification Sex M Recertification F Follow-up Driver License No. License Class State of Issue C D A B Home Tel 2. HEALTH HISTORY Date of Exam Other Yes No Any illness or injury in the last 5 years Head/Brain injuries disorders or illnesses...

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How to fill out printable dot physical forms

How to fill out dot physical form:

01

Ensure you have all necessary personal information, including your name, date of birth, address, and contact information.

02

Answer the medical history questions accurately and truthfully, providing details on any previous medical conditions, surgeries, or medications taken.

03

Undergo a thorough physical examination conducted by a certified medical examiner, including measurements of height, weight, blood pressure, and vision tests.

04

Complete all required sections of the form, such as the driver's information, certifications, and attestations.

05

Sign and date the form, verifying that all the information provided is accurate and true.

Who needs dot physical form:

01

Commercial drivers who operate vehicles that require a CDL (Commercial Driver's License) are typically required to undergo a DOT (Department of Transportation) physical and fill out the corresponding form.

02

This includes individuals driving large trucks, buses, or vehicles that transport hazardous materials.

03

It may also be required for individuals seeking employment as commercial drivers or those who need to renew their commercial driver's license.

Who needs a DOT Medical card?
What is DOT Medical card for?
Is DOT Medical card accompanied by other forms?

Who needs a DOT Medical card?

A person who is going for a commercial driver license should complete this Medical Examination Report (also known as Form 649 F) in order to obtain commercial driver fitness determination.

What is DOT Medical card for?

The DOT Medical Examination form provides information obtained on the basis of the driver's examination and medical report resulting from examiner’s inspection of the driver. On the basis of the received medical opinion, the Commission shall decide to what extent the health and physiological patterns of the driver can influence the professional activity.

Is DOT Medical card accompanied by other forms?

The DOT 649 F form does not require any additional documents. However, you can keep in readiness all the medical reports that you have in the case of need.

When is DOT Form 649 due?

Duration of this medical examination report is determined by the period of validity of the license. License renewal will require the passage of a new commission.

How do I fill out DOT Physical Exam Forms?

This form is filled with the help of the medical examiner. Some of the form’s parts are filled out by them. Following information should be given to complete DOT Medical Card:

Driver’s Information (driver completes this section);
Health History (driver completes this section);
Testing Section (vision, hearing, blood pressure and laboratory test should be completed by examiner).

Where do I send DOT Medical card?

Completed and signed by the examiner, this form remains with the examiner. In exchange, an applicant will receive a certificate, which confirms the fact of the examiner checks and indicates the possible scope of work of the driver.

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What is dot medical form?

The Federal Motor Carrier Safety Administration requires that interstate commercial motor vehicle drivers maintain a current Medical Examiner's Certificate (MEC), Form MCSA-5876 to drive.

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What is dot physical form?

A DOT physical form is a form completed by a healthcare provider for drivers of commercial motor vehicles that certifies they meet the medical standards required by the Federal Motor Carrier Safety Administration (FMCSA). The form is also known as a Department of Transportation Medical Examiner's Certificate. It is used to ensure that drivers have no medical conditions that could render them unsafe to drive.

Who is required to file dot physical form?

DOT physical forms must be completed and signed by medical examiners certified by the Federal Motor Carrier Safety Administration (FMCSA) and must be completed for all commercial motor vehicle drivers who are subject to the DOT physical requirements.

How to fill out dot physical form?

1. Provide your Personal Information: On the top of the form, provide your name, address, phone number, and other contact information. 2. List your Medical History: On the form, you will need to list any medical conditions that you have been diagnosed with or have been treated for in the past five years. Include the name of the condition, any medications that you have taken, and the date of any medical procedures you have had. 3. Answer the Medical Questions: The form will include several questions about your medical history, such as whether you have had any surgeries in the past five years or if you have any disabilities that may interfere with your ability to safely operate a commercial vehicle. Answer all questions honestly and accurately. 4. Provide Additional Documents: Depending on the type of DOT physical you are getting, you may need to provide additional documents, such as a copy of your driver’s license and a list of medications that you take. 5. Sign the Form: Before submitting the form, make sure to sign and date the bottom of the form.

What is the purpose of dot physical form?

The purpose of a DOT physical form is to ensure that a driver is medically fit to safely operate a commercial motor vehicle. The form is filled out by a certified medical examiner to assess the driver’s health and help ensure the safety of other drivers on the road.

What information must be reported on dot physical form?

1. Personal Information: Name, address, phone number, date of birth, gender, and height/weight. 2. Medical History: List of current medications, past medical history, and any known allergies. 3. Physical Exam: Blood pressure, vision, urine specific gravity, and hearing results. 4. Vision Exam: Visual acuity test and color blindness test. 5. Audiometric Exam: Hearing test. 6. Pulmonary Exam: Spirometry test results. 7. Health Professional Evaluation: Assessment of any physical or mental health conditions that may interfere with safe operation of a commercial motor vehicle. 8. Drug and Alcohol Testing: Documentation of drug and alcohol testing results.

When is the deadline to file dot physical form in 2023?

The deadline to file a DOT physical form for 2023 has not yet been determined. It is recommended that you check with your local Department of Transportation for more information.

What is the penalty for the late filing of dot physical form?

The penalty for the late filing of a DOT physical form is that the individual may not be allowed to operate a commercial motor vehicle until the form is submitted. Depending on the circumstances, the individual may also face civil or criminal penalties.

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