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
Coast Guard- Merchant Mariner Forms
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
- 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
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 21062Maryland Intrastate Waiver Program: CDL Medical Waiver Information Packet
Mail: Delaware Division of Motor Vehicle. Attn CDL Department P.O. Box 698
Dover, DE 19903. Fax (302)739-2602
Northeast(excludes above)
Bureau of Motor Vehicles
CDL Compliance Unit
29 State House Station
Augusta, ME 04333-0029Fax 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
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
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
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
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.
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.
Mail to: WV DMV PO Box 17010 Charleston, WV 25317
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.
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
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
Midwest
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.
-
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
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 Department of Motor Vehicles
Driver and Vehicle Records Division
301 Centennial Mall South
P.O. Box 94789
Lincoln, NE 68509-4789Phone # (402) 471-3918
Fax # (402) 471-8694
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)
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)
- 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
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
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
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);
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
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 Intrastate Waiver link
Washington Intrastate Waiver Link
Visiting a CDL/CLP office
Email:CDLMED@dol.wa.gov
Fax: 360.570.4915
CDL Medical Unit
Department of Licensing
PO Box 9030
Olympia, WA 98507-9030
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
Alaska
Contact Us: (to book your DOT physical now!)
- 718-701-5949
- doctor@dotmedicalexaminer.com
- 120-10 15th Ave.
Rm. 6
College Point , NY 11356
You must log in to post a comment.