About this Form

If the medical examiner finds that the person he/she examined is physically qualified to drive a commercial motor vehicle (CMV), the medical examiner will complete a Medical Examiner's Certificate and give the original to the person who was examined.  The medical examiner will keep a copy of the Medical Examiner's Certificate on file for at least 3 years. If a driver wishes the Certificate to be in card form, he/she may:

• Purchase a separate "medical card" from an industry supplier of motor carrier forms (e.g., State trucking association) before the physical exam and ask the medical examiner to complete and sign it, in addition to the Medical Examination Report form; or
• Print the Certificate on cardstock paper. It is permissible to reduce the size of the Certificate.