Medical Examination Certificate, Large - Snap-Out, 2-Ply, Carbonless, 5-2/3" W x 9-7/8" L

Regulatory Alert: Effective January 16, 2024,
The FMCSA revised its Medical Examiner’s Certificate and Medical Examination Report Form to remove an obsolete reference. The new forms may be identified by a revision (rev) date, respectively, of “3/1/23” and “2/28/2023” in the lower corner (the date in the upper corner remains 3/31/2025). The FMCSA is allowing medical examiners to use up their existing stock of older forms, and is encouraging state licensing agencies to continue accepting them, beyond the January 16 deadline. However, motor carriers and medical examiners are advised to switch to the new forms as soon as possible.

• Helps you comply with 49 CFR §391.43
• Two plies
• Measures 5-2/3” x 9-7/8”
• Both the Medical Examination Report and Medical Examination Certificate/DOT Medical Card are required by the DOT

View Sample

View a sample Medical Examination Certificate - Large.