IN CDL-PHY SF 49867 2004 free printable template
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Your physical examination form to: Indiana Department of Revenue, Motor Carrier Services, CDL Section, 5252 Decatur ... NOTE: All four (4) pages of the Medical Examination Report for ..... Blood Pressure
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How to fill out IN CDL-PHY SF 49867
How to fill out IN CDL-PHY SF 49867
01
Gather all necessary personal information such as your name, address, and contact details.
02
Provide your driver's license number if applicable.
03
Fill out the section detailing your physical condition, including any medical conditions or disabilities.
04
Include the date of your last medical examination if required.
05
Sign and date the form at the bottom to certify that the information provided is accurate.
Who needs IN CDL-PHY SF 49867?
01
Individuals applying for a commercial driver's license who have specific medical requirements.
02
Drivers with a history of medical conditions that may affect their ability to operate a commercial vehicle.
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OMB 2126-0006. The revision to the ICR is due to the Agency's development of a final rule titled Qualifications of Drivers; Diabetes Standard to revise its regulations to eliminate the blanket prohibition against insulin-dependent diabetic individuals' operation of CMVs in interstate commerce.
How do I get a PA DOT medical card?
In Person: At your local PennDOT Driver License Center. PennDOT will mail you a receipt indicating that the Medical Examiner's Certification and/or Self-Certification Form has been processed.
What are the requirements for a DOT physical in PA?
The DOT physical requires drivers to have 20/40 vision with or without the use of corrective lenses. This means you must be able to see at least 20/40 with both eyes, or at least 20/40 with either the right eye or left eye. Those with monovision may be disqualified from getting a DOT medical card.
What is a MCSA 5876 form?
If the Medical Examiner determines that the driver examined is physically qualified to drive a commercial motor vehicle in ance with the physical qualification standards, the Medical Examiner will complete and provide the driver with a Medical Examiner's Certificate (MEC), Form MCSA-5876.
How much does a DOT physical cost in Pennsylvania?
DOT Physicals at MinuteClinic typically costs $109, while all MinuteClinic® prices in Lancaster range anywhere from $35 to $250 depending on the service.
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What is IN CDL-PHY SF 49867?
IN CDL-PHY SF 49867 is a form used for reporting physical activity levels related to commercial driving licenses in the state of Indiana.
Who is required to file IN CDL-PHY SF 49867?
Individuals applying for or renewing a commercial driving license in Indiana are required to file IN CDL-PHY SF 49867.
How to fill out IN CDL-PHY SF 49867?
To fill out IN CDL-PHY SF 49867, it is necessary to provide personal identification information, details of physical activity levels, and any relevant medical history.
What is the purpose of IN CDL-PHY SF 49867?
The purpose of IN CDL-PHY SF 49867 is to ensure that applicants for a commercial driving license meet the physical fitness requirements mandated by state regulations.
What information must be reported on IN CDL-PHY SF 49867?
The form requires reporting on the applicant's physical health, medical conditions, medications, and any other factors that could affect their ability to drive commercially.
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