DOT Medical Examination Forms-Certificate (download)

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Commercial Driver Fitness Determination (truck & bus drivers).

  • Medical Examination Report Form (MER):  MCSA-5875
  • Medical Examiner’s Certificate (MEC):         MCSA-5876

Federal Exemption Programs For Commercial Drivers

Coast Guard- Merchant Mariner

Republic of Marshall Islands 


Driver Medical Examination Forms by State/Region

Tri-State Area & Pennsylvania 

 

 

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.

 

 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

 

 

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 04333-0029

Fax to: (207)-624-9339

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

 

 

 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.

 

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

 

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 68509-4789

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

E-Mail

 

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 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:
    • Fax Number: 512-424-2002

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

    • Email: CDLMedCert@dps.texas.gov (Documents must be submitted in PDF format.)

 

 

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

 

           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

 

 

 

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

Mail
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!)

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