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F. NO. 680 (Rev.2022) Date of Receipt Inward No. ___ PERSONAL STATEMENT REGARDING HEALTH (Revival of Lapsed Policies on both Medical & NonMedical basis) Division Office:Branch office:Agents Name : Policy

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How to fill out 16 medical examiners certificate

01

Gather all necessary information and documentation

02

Complete the driver's section with personal information

03

Fill out the medical examiner's section with the provider's information

04

Answer all medical questions accurately

05

Sign and date the certificate

Who needs 16 medical examiners certificate?

01

Commercial motor vehicle drivers who are required to have a medical exam as part of their job duties

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What is 16 medical examiners certificate?

The 16 medical examiners certificate is a document required by the Federal Motor Carrier Safety Administration (FMCSA) that certifies a commercial driver has undergone a medical examination and meets the physical requirements to operate a commercial vehicle.

Who is required to file 16 medical examiners certificate?

Commercial drivers who operate vehicles that require a Commercial Driver's License (CDL) must file the 16 medical examiners certificate to verify their medical fitness for driving.

How to fill out 16 medical examiners certificate?

To fill out the 16 medical examiners certificate, the driver must complete personal information, answer medical history questions, and have a qualified medical examiner complete the examination and sign the certificate.

What is the purpose of 16 medical examiners certificate?

The purpose of the 16 medical examiners certificate is to ensure that commercial drivers are physically capable of operating a vehicle safely, reducing the risk of accidents caused by medical conditions.

What information must be reported on 16 medical examiners certificate?

The certificate must include the driver's name, date of birth, medical history, results of the physical examination, the medical examiner's name and contact information, and the examiner's certification statement.

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