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Fillable 649-f(6045) - Medical Examination Report for Commercial Driver Fitness Determination - fmcsa dot

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Medical Examination Report FOR COMMERCIAL DRIVER FITNESS DETERMINATION 649-F (6045) 1. DRIVER'S INFORMATION Driver completes this section Driver's Name (Last, First, Middle) Social Security No. Birthdate M/D/Y Age New Certification Sex M Recertification F Follow-up A B Other C D Date of Exam Address City, State, Zip Code Work Tel: ( ) Home Tel: ( ) Driver License No. License Class...
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