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SPEC-3 FORM MISSOURI DEPARTMENT OF TRANSPORTATION MOTOR CARRIER SERVICES (APPLICANT WITH INSULIN-TREATED DIABETES MELLITUS (ITDM)) APPLICATION FOR SKILL PERFORMANCE EVALUATION (SPE) CERTIFICATE TO OPERATE INTRASTATE COMMERCIAL MOTOR VEHICLES MAIL COMPLETED FORM TO: ATTN: MEDICAL EXEMPTION PROGRAM MOTOR CARRIER SERVICES P.O. BOX 893 JEFFERSON CITY, MO 65102-0893 IF ASSISTANCE NEEDED, CALL: 573-522-9001 OR Toll Free at 1-866-831-6277 FAX 573-522-4260 SECTION 1. INDIVIDUAL OR JOINT APPLICATION CHECK THIS BOX IF INDIVIDUAL DRIVER APPLICATION More


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SPEC 3FORM INSULINTREATEDDIABET ESMELLITUS1
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MISSOURI SPE CFR MELLITUS SPEC-3 ITDM MoDOT FMCSA CDL USDOT SPEC-2 REVOCATIONS SPEC-1 SEMITRAILERS DISMISSALS PHYSIATRIST DIABETEC Lowboy PROLIFERATIVE eligile 2-Speed RETINOPATHY 3-Speed ENDOCRINOLOGIST INTRASTATE CERTIFICATIONS REVOCATION INSURERS CERTI


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