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Medical Examination Report FOR COMMERCIAL DRIVER FITNESS DETERMINATION 1. 2. Medical Examiner's Comments on Health History Name: Last, First, Middle, Standard: At least 20/40 acuity (Snellen) in each

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How to fill out FMCSA medical examination report:

1. Begin by accessing the FMCSA website or contacting a local FMCSA office to obtain the official medical examination report form.
2. Fill out the personal information section at the top of the form, including your full name, date of birth, and contact information.
3. Provide details about your medical examiner, such as their name, address, and phone number.
4. Answer the questions related to your medical history, including any previous or current medical conditions, medications, surgeries, and treatments.
5. Fill in the section regarding your vision, including your visual acuity and any corrective lenses used.
6. Answer the questions related to your hearing ability, such as your ability to hear a forced whisper or understand speech in a normal conversation.
7. Provide information about your cardiovascular health, including any heart conditions, high blood pressure, or previous surgeries.
8. Fill out the information about your respiratory system, including details about any breathing difficulties or respiratory conditions.
9. Answer the questions regarding your neurological health, such as any history of seizures, loss of consciousness, or neurological disorders.
10. Provide information about your mental health and emotional stability, including any history of psychiatric disorders or substance abuse.
11. Indicate any extremity impairments, including limb amputations, loss of function, or limitations.
12. Answer the questions related to your muscular system, including any muscle disorders or difficulty with coordination.
13. Fill out the substance abuse section, indicating if you have a history of drug or alcohol abuse.
14. Provide any additional information requested on the form, such as details about your sleep apnea or diabetes management.
15. Sign and date the form, affirming the accuracy and completeness of the information provided.

Who needs FMCSA medical examination report:

1. Commercial drivers: Any individual operating a commercial vehicle that requires a commercial driver's license (CDL) needs to complete the FMCSA medical examination report. This includes truck drivers, bus drivers, and commercial vehicle operators.
2. Employers and motor carriers: Employers and motor carriers are responsible for ensuring that their drivers maintain a valid FMCSA medical examination report. They may request the report before hiring a driver or on a regular basis to ensure the physical fitness of their employees.
3. State and federal regulatory authorities: State and federal regulatory authorities use the FMCSA medical examination report to validate the physical qualifications and medical fitness of commercial drivers. It helps in ensuring the safety and health standards are met and maintained on the roads.

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What is fmcsa medical examination report?

The FMCSA medical examination report is a form used to assess the physical qualifications of commercial motor vehicle drivers.

Who is required to file fmcsa medical examination report?

All commercial motor vehicle drivers are required to file FMCSA medical examination reports.

How to fill out fmcsa medical examination report?

FMCSA medical examination reports can be filled out by a qualified medical examiner during a physical examination of the driver.

What is the purpose of fmcsa medical examination report?

The purpose of the FMCSA medical examination report is to ensure that commercial drivers are physically able to safely operate a commercial motor vehicle.

What information must be reported on fmcsa medical examination report?

FMCSA medical examination reports must include information about the driver's medical history, current health status, and any prescribed medications.