Get the free BMedicalb-Order-bFormb-U - Utah Trucking Association

MEDICAL EXAMINATION REPORT ORDER FORM UTAH TRUCKING ASSOCIATION 4181 W. 2100 S. West Valley City, Utah 84120 ×801) 973-9370 FAX (801) 973-8515 DESCRIPTION PRICE DOT MEDICAL CARDS (25) DOT MEDICAL

How to fill out bmedicalb-order-bformb-u - utah trucking

How to fill out the Medical Order Form-Utah Trucking:

1. Obtain the form: The first step is to obtain the Medical Order Form-Utah Trucking. You can usually obtain this form from the Utah Department of Transportation (UDOT) website or local UDOT offices.
2. Patient Information: Fill out the patient's information accurately. This includes the patient's full name, date of birth, address, and contact details. Ensure that all information is up to date and correct.
3. Physician Information: Provide the physician's information on the form. This includes the physician's name, medical license number, address, and contact details. Make sure to include the physician who is recommending the medical order.
4. Medical Condition: Indicate the specific medical condition of the patient that requires attention or treatment. Include any relevant details about the condition, such as its severity or potential impact on the patient's ability to drive safely.
5. Prescription Details: If the medical order requires a prescription, provide detailed information about the prescribed medication or treatment. This includes the name of the medication, dosage, frequency, and any special instructions.
6. Expiration Date: Specify the expiration date for the medical order. Typically, medical orders have an expiration date after which they need to be renewed or updated.
7. Signature and Date: Ensure that both the physician and the patient sign and date the form. This verifies that the information provided is accurate and that both parties agree to the medical order.

Who needs Medical Order Form-Utah Trucking?

1. Commercial Truck Drivers: Commercial truck drivers who have a medical condition that may affect their ability to operate a truck safely or meet the medical qualifications set by the Utah Department of Transportation may need to fill out the Medical Order Form-Utah Trucking.
2. Physicians: Physicians who are responsible for assessing and diagnosing medical conditions in commercial truck drivers may need to complete this form to provide necessary medical documentation for their patients.
3. Utah Department of Transportation: The Utah Department of Transportation requires commercial truck drivers to submit the Medical Order Form-Utah Trucking as part of their commercial driver's license (CDL) application or renewal process.

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