After a DOT physical recorded on MCSA-5875, the certified medical examiner issues this one-page certificate to an interstate commercial driver found physically qualified. It states whether the exam followed the federal standards or a state's intrastate variances, any conditions such as corrective lenses, a hearing aid, an exemption, a Skill Performance Evaluation certificate or an intracity zone, and the date certification expires, no more than 24 months later.
A medical examiner certified on FMCSA's National Registry completes and signs the certificate, including the examiner's license number, issuing state and National Registry number. The driver signs it and supplies their address, driver's license number, issuing state and CLP/CDL status.
Enter the driver's last and first name, then check one examination standard: the Federal Motor Carrier Safety Regulations (49 CFR 391.41-391.49), or those regulations with any applicable State variances, which are valid only for intrastate operations. The box must match the determination section completed on the MCSA-5875, Federal or State. The statement certifies that, with knowledge of the driving duties, the examiner finds the person qualified.
Check each condition the driver's qualification depends on: wearing corrective lenses, wearing a hearing aid, accompanied by a waiver or exemption, accompanied by a Skill Performance Evaluation (SPE) certificate, driving within an exempt intracity zone under 49 CFR 391.62 (federal only), or grandfathered from State requirements (state only). These should mirror the categories checked in the MCSA-5875 determination; FMCSA's instructions say an exemption for a disqualifying condition is recorded on both forms.
By signing, the examiner states that the information is true and complete and that a complete MCSA-5875, with any attachments, is on file in the office. Enter the examiner's printed name, telephone number, state license, certificate or registration number and issuing state, and National Registry number, and check the credential: MD, DO, physician assistant, advanced practice nurse, chiropractor or other practitioner.
Enter the date signed and the expiration date. A driver who meets the standards qualifies for up to 24 months. When the MCSA-5875 records periodic monitoring for 3 months, 6 months, 1 year or another period, the expiration date reflects that shorter period, and it should match the certificate expiration date the examiner entered on the report.
The driver signs and the certificate records the driver's street address, city, state or province and ZIP code, driver's license number and issuing state or province, and whether the driver is a CLP or CDL applicant or holder. The CLP/CDL answer matters under National Registry II, which sends CLP and CDL holders' results electronically to the state licensing agency.
Download the current version from the source each time; forms change without notice.
Medical Examiner's Certificate (for Commercial Driver Medical Certification)
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Sources for this guide
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Up to 24 months from the exam. The certified medical examiner can choose a shorter period to monitor a condition such as high blood pressure, and the expiration date the examiner enters on MCSA-5876 marks when the driver's medical certification ends.
Not in states that have implemented National Registry II, whose compliance date was June 23, 2025. There, CLP and CDL holders' results go electronically from the National Registry to the state licensing agency, and the paper certificate no longer serves as proof. Non-CDL interstate drivers still carry the certificate.
The examiner checks all that apply: wearing corrective lenses, wearing a hearing aid, accompanied by a waiver or exemption, accompanied by a Skill Performance Evaluation certificate, driving within an exempt intracity zone (federal certificates) or grandfathered from state requirements (state certificates). The certificate also carries the examiner's National Registry number and the expiration date.
Yes. The certificate has a driver's signature line next to the examiner's, along with the driver's address, driver's license number, issuing state and whether the driver holds or is applying for a commercial learner's permit or CDL. The examiner completes everything else, including the examination standard, conditions, credentials and expiration date.