The FMCSA exam report and certificate, the treating-provider forms that support them, drug testing forms and the Coast Guard's mariner medical application.
Interstate commercial drivers must pass a DOT physical with a certified medical examiner listed on the FMCSA National Registry. The examiner records the exam on the Medical Examination Report Form (MCSA-5875) and issues the Medical Examiner's Certificate (MCSA-5876), valid for up to 24 months. Treating clinicians see the supporting forms: the Insulin-Treated Diabetes Mellitus Assessment Form (MCSA-5870) and, for eye specialists, the Vision Evaluation Report (MCSA-5871). Merchant mariners bring the Coast Guard's Application for Medical Certificate (CG-719K).
The driver fills in the health history in Section 1 of the MCSA-5875. The examiner completes Section 2, keeps the report for at least 3 years and uploads the result to the National Registry by midnight of the next calendar day. The MCSA-5870 and MCSA-5871 go back to the driver, who has 45 days to see the examiner. The MCSA-5872 and MCSA-5895 are optional requests from the examiner to the treating or prescribing provider. Vero Documents fills these PDFs from the visit note and chart, and you review and sign.
Records the DOT physical qualification examination of an interstate commercial motor vehicle driver against 49 CFR 391.41 and the examiner's determination.
Certifies that an interstate CMV driver is physically qualified, with any conditions (corrective lenses, hearing aid, exemption, SPE certificate, intracity zone) and an expiration date.
Chain-of-custody and result form for federally regulated (including FMCSA, FAA, FRA, FTA, PHMSA and USCG) urine or oral-fluid drug tests, on which the Medical Review Officer records the verified result.
Merchant mariner's medical and physical examination (conditions, medications, exam, vision, hearing, physical ability) used by the Coast Guard to issue a national/STCW medical certificate under 46 CFR Part 10.
Documents a DOT drug test within the past 185 days, verified by a Medical Review Officer, to meet the merchant mariner periodic drug testing requirement (46 CFR 16.220).
Treating clinician attests that a CMV driver with insulin-treated diabetes has a stable insulin regimen and properly controlled diabetes (glucose monitoring, hypoglycemia, HbA1c, complications).
MCSA-5871Ophthalmologist or optometrist documents visual acuity, fields, color recognition and stability for a driver who cannot meet the vision standard in the worse eye (alternative vision standard, 49 CFR 391.44).
Optional request from the certified medical examiner to the treating provider for diagnosis, monitoring and stability details of a driver's non-insulin-treated diabetes.
MCSA-5895Optional request from the certified medical examiner asking the prescribing provider to list medications and give an opinion on whether they or the treated conditions impair safe CMV operation (49 CFR 391.41(b)(12)).
Treating physician's letter supporting an interstate CMV driver's exemption from the epilepsy/seizure standard (49 CFR 391.41(b)(8)): diagnosis, last seizure, anti-seizure medication history and support to drive.
Physiatrist or orthopedic surgeon assesses a driver's limb loss or impairment, prosthesis/orthosis and precision and power-grasp prehension for an SPE certificate under 49 CFR 391.49.
Short-form medical exam for mariners with only entry-level or staff-officer endorsements (food handlers, or STCW/MLC certificates without watch or lookout duties).
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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Only a certified medical examiner listed on FMCSA's National Registry of Certified Medical Examiners. That can be an MD, DO, PA, advanced practice nurse, chiropractor or other licensed practitioner who has completed the registry training and passed the certification test. The examiner completes Section 2 of the MCSA-5875, issues the MCSA-5876 and reports every exam to the National Registry by midnight of the next calendar day.
Before each DOT physical. The treating clinician who prescribes the insulin (MD, DO, PA or NP) completes the whole Insulin-Treated Diabetes Mellitus Assessment Form, covering glucose monitoring, hypoglycemia, HbA1c and complications. The driver needs 3 months of electronic glucose self-monitoring records and must bring the form to the certified medical examiner within 45 days of its completion.
Not everywhere. Since the National Registry II compliance date of June 23, 2025, exam results for CLP and CDL holders go electronically from the National Registry to the state driver licensing agency. In states that have implemented it, the paper MCSA-5876 is no longer proof of certification for CLP and CDL holders. Non-CDL interstate drivers still carry the certificate, and the examiner keeps a copy for 3 years.
A physician, physician assistant or nurse practitioner licensed by a U.S. state or territory, though exams for registered pilots require a licensed medical doctor. The clinician completes the physical exam, vision, hearing and physical ability sections and signs the summary, then returns the form to the mariner, who submits all 10 pages to the National Maritime Center. Mariners with entry-level endorsements only can use the shorter CG-719K/E.