Try for free

MA VSC103: School Bus/7D Cardiovascular Evaluation

Massachusetts school bus and 7D school pupil transport applicants who have an implanted cardiac defibrillator need VSC103 under 540 CMR 2.15. The physician records the implant date and certifies whether the device, placed for a sudden death event or prophylactically, has not fired in six months, whether the applicant is AHA Class I or II or has no heart disease, and whether the applicant is medically qualified.

Who completes it

A licensed physician completes the whole one-page form, adds Board of Registration in Medicine and NPI numbers, and signs the attestation. The applicant completes Section A and also signs.

Submitting and payment

How to submit it
Submit it with the completed 7D School Pupil Transport Certificate Application. It is a flat PDF, so it is printed and completed by hand.

Good to know

  • AHA functional Class III or IV heart disease disqualifies a school bus or 7D applicant, so question 3 accepts only Class I, Class II or no heart disease.
  • A defibrillator placed for a sudden death event bars an active certificate until six months pass with documented absence of appropriate firing.
  • VSC109, the general medical form, asks about an implanted cardiac defibrillator and sends applicants who answer yes to this cardiovascular form.
  • Drivers previously ineligible because of a defibrillator or Class III or IV status can use this form as the provider's written statement to regain eligibility.

Get the official form

Download the current version from the source each time; forms change without notice.

School Bus and School Pupil Transport (7D) Operator Cardiovascular Medical Evaluation Form

Official pagePDF

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

See how Vero Documents works

How this list is checked

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.

Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.

Frequently asked questions

Does every 7D or school bus applicant need VSC103?

No. It is for applicants with an implanted cardiac defibrillator. Other applicants complete only the general medical form, VSC109, where the clinician answers whether the applicant has an implanted defibrillator; a yes answer triggers this form.

What if the defibrillator has fired?

The applicant is not eligible for an active certificate until there is a six-month period with documentation of no appropriate device firing. The physician then certifies on VSC103 that the device has not fired in six months and gives the implant date.

Who can sign VSC103?

A licensed physician. The physician attests, to a reasonable degree of medical certainty, that the applicant is safe to operate a vehicle transporting school pupils under 540 CMR 2.15 and can fulfill the duties that come with that operation.