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391. 41 CMV DRIVER MEDICATION FORM Driver Name DOB The above patient/driver is being evaluated to determine whether he/she meets the medical standards of the Federal Motor Carrier Safety Administration FMCSA to operate a commercial motor vehicle CMV in interstate commerce. B has no medical condition s that I am treating with the above medication s that would adversely affect the ability to safely operate a CMV. During the medical evaluation it was determined this individual is taking...
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The OMB control number 2126-00xx is used to track and manage information collection requests approved by the Office of Management and Budget.
Entities or individuals specified in the instructions of the form associated with OMB control number 2126-00xx are required to file.
To fill out OMB control number 2126-00xx, follow the instructions provided on the form associated with the control number and provide all the requested information accurately.
The purpose of OMB control number 2126-00xx is to collect specific information as requested by the issuing agency for regulatory, statistical, or other purposes.
The specific information to be reported on OMB control number 2126-00xx will be outlined in the instructions of the associated form.
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