Medical Examination Certificate & Report Combo Pack Main Image

Medical Examination Certificate & Report Combo Pack

Certificate and report combo pack helps you comply with 49 CFR §391.43 DOT medical card requirements.

Product Code:59603
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Regulatory Alert: Effective April 1, 2025
The FMCSA has reissued its Medical Examiner’s Certificate and Medical Examination Report Form with a new OMB expiration date of “3/31/2028” in the upper right corner and a revision (rev) date of “3/27/25” in the lower right corner. The FMCSA is allowing medical examiners to use up their existing stock of older forms. FMCSA is encouraging, but not requiring, state licensing agencies to continue accepting them. However, motor carriers and medical examiners are advised to switch to the new forms as soon as possible.

Temporarily on backorder. Expected availability 5/5/2025 (subject to change).

Product Information

Medical Exam Form and Medical Examination Certificate required by the DOT

Form and certificate combo pack includes:

  • Medical Examination Certificate – Laminated (47379)
    • Medical Exam Certificate helps you comply with 49 CFR §391.43
    • Features front laminate to protect driver's copy
    • Certificate is two ply and self-laminating
    • Tri-fold format allows certificate to fit in wallet
    • Overall measurement: 3-1/2" x 7-1/8"
    • Certificate detached measures: 3-1/2" x 6-1/2"
    • Folded measurement: 3-1/2" x 2-3/16"
    • Quantity: 50
  • Medical Examination Report Form (47375)
    • Medical Examination Report Form helps you comply with 49 CFR §391.43
    • DOT medical exam form is 9 pages long
    • Contains form, applicable regulations and instructions to medical examiner
    • Measures 8-1/2" x 11"
    • Quantity: 50

Compliance Topic: Injury & Illness Recordkeeping, Driver Qualification & Hiring

Industry: Human Resources, Transportation

Quantity: 50 each

Advantage Savings: Advantage Savings

Country Of Origin: USA