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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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DRIVER S D E N T S Date of Interview Social Security No. Social Security Number Age (if not 19 years old) Birthdate Sex M/D/Y Address City State Zip Code F M M F M M M F F M M M F M 4. DRIVER D E M I D I N T S (S) DATE OF QUESTION F.R.C.I.S./E.U.C. DATE OF CONTACT F.R.R.C.I.S/E.U.C. STATE MAINLAND FILLED DATE OF CONTACT 5.

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.

Social Security Number Age (if not 19 years old) Birthdate Sex M/D/Y Address City State Zip Code F M M F M M M F F M M M F M 4.
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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