FMCSA Commercial Driver Fitness Determination (truck & bus drivers).

• Medical Examination Report Form (MER):  MCSA-5875
• Medical Examiner’s Certificate (MEC):         MCSA-5876
• Insulin Treated Diabetes Mellitus, Assessment Form:  MCSA-5870

FMCSA Federal Exemption Programs For Commercial Drivers

• Federal Diabetes Exemption (application package)
• Quartely-Endocrinologist-Evaluation-Form-508
• Diabetes-Annual-Endo-Vision-Evaluation-Checklist-508
• Vision Exemption (application package)
• Florida Vision_Exemption_Package
• Indiana Vision_Exemption_Package
• SPE- Skill Performance Evaluation Certificate Application  
• FMCSA Seizure Exemption Application

Other FMCSA Driver Forms

• 39141-cmv-driver-medication-form-mcsa-5895

Coast Guard- Merchant Mariner Forms

• CG-719B, CG-719K, CG-719E, CG-719C CG-719S, CG-719P

Republic of Marshall Islands 

• Marshall Island Physical Exam FormGuidance on Medical Exams and Certificates for Seafarers MG-7-47-1

Driver Medical Examination Forms by State/Region

Tri-State Area & Pennsylvania 

• New York:  NYS DMV mc11a – Medical Certification Requirements For Commercial Driver;  Medical Certification Unit Contact Information:
  

  Fax: 518-486-4421 or 518-486-3260 Email: dmv.sm.cdlmedcertunit@dmv.ny.gov Mail to: NYS Department of Motor Vehicles
  Medical Certification Unit
  PO Box 2601
  Albany, NY  12220-0601

• NYS DMV Article 19-A Information and Forms 
  • DS874- Medical Examination of Driver Under Article 19-A
  • Supplement To: Medical Examination of Driver Under Article 19-A
  • Article 19-A Bus Driver’s B.P. Follow Up
  • NYC Board of Education Office of Pupil Transportation Medical Examination

  New York City Taxi & Limousine Commision 

  • NYC TLC Medical Certification Forms:  Medical Certification Form-New Application;   Medical Certification Form For-Hire Vehicle Renewing Applicants
• New York City Department of Buildings
  • Physical Examination Form

• Connecticut CDL:  Self Certification Form (electronic);  DOT Physical form R-323; Medical Examiner’s Certificate;
  You are required to fax your medical certification to:
  FAX:  (860) 263-5568

• New Jersey CDL: nj_med_cert_affidavit; CDL_FAQs;

MAIL TO: NJ Motor Vehicle Commission Driver Review Bus Application Unit PO Box 127 Trenton, NJ 08666 For further assistance, contact the MVC Bus Application Unit by phone at (609) 292-7500 ext. 5039.

• Pennsylvania CDL:  Self Certification Forms DL-11CD;

 Please mail the Self-Certification form and medical certificate (if applicable) to: Bureau of Driver Licensing • P.O.Box 69008 • Harrisburg, PA 17106-9008

Mid-Atlantic

• Maryland:  CDL Self Certification Form;  Frequently asked questions.
  

  Option #1	Email address: cdlmedcert@mva.maryland.gov (scanned copies only)
  Option #2	FAX: 410-787-7959
  Option #3	For mail or in-person deliveries:
  	Maryland MVA 6601 Ritchie Highway, N.E. Room 145, Attn: CDL Med Cert Glen Burnie, MD 21062

  Maryland Intrastate Waiver Program:  CDL Medical Waiver Information Packet

• Washington D.C. (District of Columbia):

• Delaware:  Do You Need a CDL Chart;

Mail:    Delaware Division of Motor Vehicle.  Attn CDL Department P.O. Box 698

Dover, DE 19903.  Fax  (302)739-2602

Northeast(excludes above)

• Maine:  CDL Self Certification Form

Bureau of Motor Vehicles
CDL Compliance Unit
29 State House Station
Augusta, ME 04333-0029

Fax to: (207)-624-9339

E-mail: cdlcompliance.BMV@maine.gov (must be scanned as a word document or pdf)

• Massachussetts:  CDL Self certification form;  Mail forms to: MassDOT, RMV Division, Driver Licensing PO Box 55889 Boston, MA 02205 Submit forms in person to: Any RMV branch office. Locations can be found by visiting http://www.massrmv.com

• New Hampshire:  Self Certification Form;

 Mail in:
NH-DMV
DRIVER LICENSING BUREAU
23 HAZEN DRIVE
CONCORD, NH 03305
E-mail the new form filled out and a scanned copy of the DRIVER LICENSE
and MEDICAL CARD in PDF form :
NHCDLMEDCARDS@dos.nh.gov

• Vermont:  Forms and Applications;  Online Services.

• Rhode Island:     CDL Self Certification Form;

STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS DIVISION OF MOTOR VEHICLES COMMERCIAL DRIVER’S LICENSE OFFICE 600 New London Avenue Cranston, RI 02920-3024 Phone: 401-462-4368 http://www.dmv.ri.gov

 

Southeast

• Florida:  CDL Self Certification Form

• Alabama:  CDL Self Certification Affidavit

• North Carolina:  CDL Self Certification Form

Email to: CDLmedical@ncdot.gov; Fax number is (919) 861-3915; Phone number is (919) 861-3599; Address: NCDMV CDL Medical Certification Unit 3126 Mail Service Center Raleigh, NC 27699-3126; website http://www.ncdot.gov/dmv

• South Carolina:  Self Certification Form DL-405A;

Mail this form and copies of medical documents to: SCDMV – CDL Help Desk PO Box 1498 Blythewood, SC 29016-0028 ; Scan the documents and then email them to: CDLHelpDesk@scdmv.net;  Fax this form and medical documents to the CDL Help Desk. Fax number is (803) 896-2676;   A list of office locations and hours can be found on our website www.scdmvonline.com Please contact the CDL Help Desk at (803) 896-2673 if you have any questions regarding this form.

• Arkansas:  Self Certification Form; FAQs;

The Self Certification Affidavit and medical certificate, may be submitted to the state at any Arkansas Revenue Office (http://www.dfa.arkansas.gov/Pages/revenueOffices.aspx) or may be mailed or faxed to: Safety Responsibility Ragland Building, Room 1120 P.O. Box 1272 Little Rock, AR 72203 Fax: (501) 682-2100 ; Phone 501-682-7100.

• Virginia:  Self Cerification Form DL 8

• West Virginia:  Medical Self Certification Affidavit DMV-CDL-3;  Forms.

Mail to:  WV DMV PO Box 17010 Charleston, WV 25317

• Georgia:  Self Certification form DS 1207;  Online Application; FAQs.;  Video:  Meet The Truck

IMPORTANT NEWS FOR CDL DRIVERS

Effective Immediately! The Department of Driver Services (DDS) will only accept CDL Self Certifications in person at a Customer Service Center.

• Tennesse:  Self Certification Form;  Medical Certification Requirements;

Tennessee Department of Safety and Homeland Security Commercial Driver License Division 1148 Foster Avenue Nashville, TN 37243.   Fax this self-certification along with your medical examiner’s certificate to: 615-401-7674 or by email the scanned copies in a PDF format to: DI.CDL.Medcert@tn.gov In the Tel. 615-687-2312.

• Louisiana:  Self Certification Information and Form;  CDL medical Inquiry;   CDL Self Certification Inquiry

Self-certifications and medical certifications can be submitted in the following ways: To any Louisiana Office of Motor Vehicles location  By fax 225-925-3901  By email at OMV_CDL_Medical@dps.la.gov

• Kentucky:  CDL Self Certification Form

Mail:  Division of Driver Licensing, 200 Mero Street, Frankfort, KY 40622 or fax to 502-564-3250 or scan and email to KYTC.CDL@ky.gov

• Mississippi:  CDL Self Certification Form;  Online CDL Medical Card Submission;  Online Services;

Midwest

• Illinois:  Self Certification Document DSD A 299

Mail to:  Illinois Secretary of State c/o CDL Medical Unit

2701 S. Dirksen Parkway Springfield, IL 62723

or by emailing a copy of the certificate to: cdlmedicalcard@ilsos.net.

• Iowa:  CDL FAQs;  How To Self Certify Flow Chart;   How to submit  a medical certificate:

  • Mailing the certificate to: Iowa Department of Transportation Office of Driver Services P.O. Box 9204 Des Moines, IA 50306-9204

  • Faxing the certificate to the Office of Driver Services at: 515-239-1837.

  • Emailing a scanned copy of the certificate to the Iowa DOT at CDLMedCert@dot.iowa.gov. (email submissions must be scanned and attached as a .pdf file).

  • Presenting the certificate in person at any Iowa driver’s license issuance site.

• Minnesotta:  Self Certification Form;

Mail to:  MINNESOTA DEPARTMENT OF PUBLIC SAFETY DRIVER AND VEHICLE SERVICES 445 Minnesota Street Saint Paul, MN 55101-5175 Phone: (651) 297-5029 Web: dvs.dps.mn.gov

• Kansas:  Self Certification Form;   FAQs.

Fill out your Medical Self Certification form and include a copy of your DOT physical card. You can mail or fax this information to:

Driver Licensing
Docking State Office Building
Attn: Medical Cert
P.O. Box 2188
Topeka, KS 66601-2128
Fax: 785-296-5859

• Nebraska:  CDL Self Certification categories;  Self Certification Form;  Medical Forms.

Nebraska Department of Motor Vehicles
Driver and Vehicle Records Division
301 Centennial Mall South
P.O. Box 94789
Lincoln, NE 68509-4789

Phone # (402) 471-3918
Fax # (402) 471-8694

E-Mail

• Michigan:   Self Certification Form;  FAQs;  Video: CDL Online Certification ;

Complete a “Self-Certification of Commercial Motor Vehicle Operation Type” and fax it to:
Michigan Department of State
CDL Help Desk
517-636-4359 (fax)

• Ohio:   CDL Self Certification Form BMV 2159 ;  CDL Eemptions;

Mail forms to:  Ohio BMV CDL/In-State Violations Unit  P.O. Box 16784 Columbus Ohio 43216-6784.  Fax (614)308-5181; email:  cdl@dps.ohio.gov

Ohio Intrastate Waiver: (Medical Exam and Provisional Medical Certification)

• Idaho:  Online CDL Self Certification;  Idaho Trucking Resources;

• Wisconsin:   Upload Your fed med card or View Your Tier of operation;   Video:  Upload your Fed Med Card;

Wisconsin DMV
P.O. Box 7995
Madison, WI 53707-7995

(608) 261-8201 – Fax

• Indiana:  Online CDL Self Certification Form;   Frequently Asked Questions; Forms and Applications.

• Missouri:  Commercial Driver’s License and Medical Certification;  Forms;  Questions & Answers;

• North Dakota:  Self Certification Affidavit;

Mail, fax, or email to: Drivers License Division 608 East Boulevard Avenue Bismarck, ND 58505-0750 or Fax to 701-328-0308 or Email with a PDF attachment to dotfaxdlmedicalcerts@nd.go

• South Dakota:  FAQs;   Self Certification Form;

Mail, fax, or email the medical certificate (if applicable) and this Self-Certification Statement to: Driver Licensing 118 West Capitol Avenue Pierre, SD 57501 Fax to 605-773-3018 Email to DPSCDLMedCert@state.sd.us

Southwest & West

• Texas:

• Mailing Address: Texas Department of Public Safety License and Record Service Attn: CDL Section P.O. Box 4087 Austin, TX 78773-0320

• Fax Number: 512-424-2002

• Email: CDLMedCert@dps.texas.gov

• Utah:  DOT/Medical Information/Intrastate;  Self Certification Form;Every time you turn in a DOT medical card you must also turn in the self-certification form.Here are the different options for turning them in:

  • At your nearest driver license office;

  • Fax them to 801-957-8633;

  • E-mail dlmedcert@utah,gov; or

  • Mail a COPY (do not send the originals) to the Driver License Division at:

  Utah Driver License Division
  ATTN: Med-Cert Desk
  PO BOX 144501
  Salt Lake City UT 84114-4501

• California: Medical Examination Certificate;  Drivers renewing their medical certificate may mail to:

Department of Motor Vehicles
CDL Unit, G204
P.O. Box 944278
Sacramento, CA 94244-2780

• Nevada:  Self Certification (Drivers certify their driving in person at the DMV);  CDL (CDL 004) Certification for waiver of Skills Test;

           Nevada Intrastate Waiver:  Commercial Medical/Vision Waiver Evaluation and Application  

• Arizona:  Check Medical Status Verification; FAQs;

Intrastate Waivers Application: (Vision and Limb Impairement/Amputation; Medical Waiver Evaluation Summary Link;  Arizona Intrastate Diabetes Waiver program;

Mail: PO Box 2100, Mail drop 818Z Phoenix, AZ 85007

Fax: 602.239.6288

Email: MedicalReview@azdot.gov

Questions: Please call 602.771.2460

• New Mexico:  Commercial Driver’s license;  Commercial Forms;  Driver Medical Conditions; Driver self Certification Form mvd11222 (3);

• Oregon:  Self Certification Form; FAQs.

• Oklahoma:  Self Certification Form

Please mail, fax, or email the medical certificate (if applicable) and the Self-Certification affidavit to: Oklahoma Department of Public Safety CDL Administration PO Box 11415 Oklahoma City, OK 73136-0415 mec@dps.state.ok.us Fax to 405-419-2196

• Colorado:  CDL Self Certification Form and Attached Medical; Forms-Licenses; Online Services.

This completed form can be faxed to 303-205-5709 Attn: CDL Unit or mailed to: Colorado Department of Revenue ATTN: CDL Unit Room 154 1881 Pierce St. Lakewood CO 80214

• Wyoming:   CDL Self Certification Forms;  Commercial Driver Forms;  What is my CDL Certification?

Wyoming Intrastate Waiver link

• Washington:  Medical Certificates and Self Certification;

Washington Intrastate Waiver Link

Visiting a CDL/CLP office

Email:CDLMED@dol.wa.gov

Fax: 360.570.4915

Mail
CDL Medical Unit
Department of Licensing
PO Box 9030
Olympia, WA 98507-9030

• Montana:  CDL Self Certification Form;  Forms;

Montana Department of Justice Motor Vehicle Division

P.O. Box 201430 Helena, MT 59620-1430  Phone (406) 444-3244  Fax (406) 444-1987 doj.mt.gov/driving/

Hawaii

• Hawaii:    CDL Self Certification Form

Alaska

• Alaska:  CDL Self Certification Form;  Medical card Requirement

Contact Us: (to book your DOT physical now!)

• 718-701-5949
• doctor@dotmedicalexaminer.com
• 120-10 15th Ave.
  Rm. 6
  College Point , NY 11356