Fillable 649-f(6045) - Medical Examination Report for Commercial Driver Fitness Determination - fmcsa dot
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.
New Certification Sex M Recertification F Follow-up A B Other C D
Date of Exam
City, State, Zip Code
Work Tel: ( ) Home Tel: ( )
Driver License No. License Class...
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