Nj dot medical card form. 303-205-5829 dor_cdlunit@state.

Nj dot medical card form Department of Transportation Federal Motor Carrier Safety Administration. Complete the Driver Information and Health History sections of the Medical Examination Report form. Both forms cover essential health information and medical history, but the comprehensive form includes additional details like vision and hearing tests. If you are deaf, hard of hearing, Form MCSA-5876, from a certified Medical Examiner listed on the National Registry. Arbitration ; Services; Interstate Tariff (702) 333-2430 If you are under the age of 21, you can only operate intrastate (within NJ only) commerce and must select commerce category 3 or 4 on the CDL Holder Self-Certification form. Submit only the Medical Doctor or Osteopathic below must submit a copy of their medical certificate; however all CDL holders, Class A, B, or C drivers must submit this certification. Driver Information (to be filled out by the driver) (or Has your USDOT/FMCSA medical certificate ever been denied or issued for less How to get a medical certificate. Includes Instructions to Physician and Commercial Drivers Minimum Requirements for a CDL License. Insulin-treated Diabetes Mellitus Assessment MCSA-5870 (PDF,255 KB) — Commercial drivers with insulin-treated diabetes need to have this form completed by their treating clinician no more than 45 days prior to examination by a certified medical examiner (CME). Make changes to the sample. By mail: New Jersey Motor Vehicle Commission, P. At age 75, you must submit to State examination every 6 months and provide your employer with a current, fully complete, Medical Doctor or Osteopathic Physician Evaluation page from the New Jersey Medical Examination Form. Bring a list of your medications. 303-205-5983 3. When do I need to submit the Commercial Driver License (CDL) Holder Self-Certification document and Medical Examiner Certificate? The Motor Vehicle Commission (MVC) Medical Review Unit is responsible for identifying high-risk drivers and taking appropriate administrative action when medical or physical conditions may compromise a driver's ability to safely operate a motor vehicle. PDF Versions of the forms are available at these links on the FMCSA website: Medical Examination Report (MER) Form, MCSA-5875; Medical Examiner’s Certificate (MEC), Form MCSA-5876 Medical Examination Report Form (for Commercial Driver Medical Certification) Last Name: Middle Initial: Street Address: Driver’s License Number: E-Mail (optional): CLP/CDL Applicant/Holder*: Has your USDOT/FMCSA medical certificate ever been denied or issued for less than 2 years? Have you ever had surgery? If “yes,” please list and explain below. Department of 1200 New Jersey Avenue, SE, Washington, D. To use the services of a skilled PDF editor, follow these steps below: 1. Requirements vary in each state, but generally, you can submit your card by visiting in person, by mail, or using online services. The medical examiner also keeps a record of this certification. Our driver file management software , Dash, keeps track of medical card Apply for a New USDOT Number and/or Authority; Update My USDOT the FMCSA does not prohibit employers from obtaining copies of the medical examination form (long form). DOT Physical By submitting this form, you are A DOT physical is a health examination mandated by the FMCSA for commercial motor vehicle (CMV) drivers. After the examination, the medical provider will send your medical certification the the state’s DMV. ; The examiner makes sure your documentation is correct and that you have a valid medical card. A potential CDL driver must hold NJ FMCSR Adoption. gov Phone: 617-494-3003. WASHINGTON, DC 20590. We prepare you for a hassle-free DOT medical Overview. Texas Commercial Driver Application - Interstate Driver Certification CDL-4; Texas Commercial Driver Application - Intrastate Driver Certification CDL-5; Certification of Physical Exemption 49 CFR PART 391/390 CDL-10; These forms allow you to certify to one of the CDL categories Medical Examination Report Form (for Commercial Driver Medical Certification) Last Name: Middle Initial: Street Address: Driver’s License Number: E-Mail (optional): CLP/CDL Applicant/Holder*: Has your USDOT/FMCSA medical certificate ever been denied or issued for less than 2 years? Have you ever had surgery? If “yes,” please list and explain below. This information may include medical exams, employment history, driving experience and motor vehicle records which must be submitted with the application. New CDL Drivers DOT Medical Exam Form, MCSA-5875, and CDL Medical Card Certificate, MCSA-5876. With or without vision corrections, each eye, as well as both eyes combined, need to have 20/40 vision. You must then provide the State Driver Licensing Agency (SDLA) the new medical examiner’s certificate. (702) 333-2430 . MEDICAL EXAMINERS MUST CONTINUE TO ISSUE MEDICAL CERTIFICATES TO ALL DRIVERS. Our Driver Friendly™ DOT Physical Doctors will get your CDL medical card right, first time. 41 CMV Driver Medication Form, MCSA-5895, requests additional information regarding medications prescribed by the treating physician as an optional tool for Medical Examiners to use in determining if a driver is medically qualified under 49 CFR 391. The DOT doctor will have the forms that are needed. During your CDL / DOT physical at Body Wellness in Clifton, Kearny, or Paterson, NJ, the examiner will check your physical health as well as performing a neurological exam and hernia If you pass the exam, you will receive a Medical Examiner's Certificate (MEC), Form MCSA-5876, valid for up to 24 months. Make your appointment for a DOT physical by calling the United Medical office in New Jersey closest to you: in Lyndhurst at (201) 460-0063, in Bayonne at (201) 339-6111, or in Clifton at (973) 546-6844. gov N/A: Disqualify until compliance Susan Archambault: 860-263-5726 susan. C. Other Information: If you are under the age of 21, you can only operate intrastate (within NJ only) commerce and must select commerce category 3 or 4 on the CDL Holder Self-Certification form. (Medical certificate and self-certification must be submitted) All Class A, B, and C drivers who do NOT fall under any of the other categories. cdl@ct. gov Phone: (202) 366-4001 Business Hours: The physical qualification examination you take for your Medical Examiner’s Certificate, Form MCSA-5876, 1200 NEW JERSEY AVENUE, SE. You may submit a legible copy of your medical certificate (medical card only, not the long form) to the DMV by mail, fax, email, or in person, as described above. Ease of Use. I've moved several times within the 2 year span of a medical card, and have never encountered this issue. Concentra is compliant with current regulations How to Get a DOT Medical Card. The goal is to ensure that drivers are in good health • Interstate non-excepted: You are an Interstate non-excepted driver and must meet the Federal DOT medical card requirements (e. Federal Motor Carrier Safety Regulations require all Commercial Driver License holders to certify with the State’s Driver License Agency in one of the four categories below prior to the issuance or renewal of a CDL. Lane has completed thousands of DOT Physicals. All our doctors are DOT Certified and validated on FMCSA National Registry of Certified Medical Examiners. You must keep a copy of the certificate in the driver’s DOT Physical Form & Medical Card Certificate, Forms MCSA-5875 & MCSA-5876 in PDF. 41 CMV Driver Medication Form, MCSA-5895 (optional): The 391. 303-205-5829 dor_cdlunit@state. This card can only be obtained once you have successfully passed a DOT Having a valid DOT medical card, also known as a medical examiner's certificate, is a requirement for interstate truck drivers. Federal Motor Carrier Safety Administration (FMCSA) regulations 49 C. Copy of your valid DOT medical card. ; The examiner will guide you reasonably and fairly through all the requirements to qualify you for a About the Medical Examiner's Certificate (MEC), Form MCSA-5876If the Medical Examiner determines that the driver examined is physically qualified to drive a commercial motor vehicle in accordance with the physical qualification standards, the Medical Examiner will complete and provide the driver with a Medical Examiner's Certificate (MEC), Form MCSA-5876. Utilize the top and left panel tools to change Cdl Are you a CMV driver and need to update your CDL/DOT physical? Stop by the Body Wellness Center in Northern NJ. A driver who doesn't keep his certification current may lose his commercial driver's licenses. Subscribe to email If you have questions regarding the medical review process, please contact the MVC’s Medical Review Unit @ (609) 292-7500 x5032 or fax to (609) 292-7504. 73 and New Jersey regulations N. 13:21-23. About the 391. I understand you have to forward them to the state when you get a new medical card, but since when did the addresses have to match? A 2 year card should be good until its expiration date, barring a change in medical condition. Public Burden Statement. If you are a Upon hire and every two years thereafter, each driver you employ has to pass a medical examination and receive a Medical Examiner’s Certificate attesting to that fact. A. Sign in. Please check only one of the following self-certification Submit the following two documents: New Jersey MVC CDL Holder Certification – download the form here from New Jersey Motor Vehicle Commission. Medical Examiners should have a release form signed by the driver if the employer wishes to 1200 NEW JERSEY AVENUE, SE. 13:60; Type 1 Type 2 Type 3 Type 4; U. JPenn, May 5, 2014 #3. Department of Transportation Requirements. Lane is dedicated to providing and an affordable and convenient DOT physical exam for There’s nothing worse than going for your DOT physical exam and not being able to get your medical card on the spot because something’s missing. Box 173, Trenton, NJ 08666-0173. Are you Medical Examination Report Form (for Commercial Driver Medical Certification) U. The Agency will make a final decision within 180 I work for a town in New Jersey and was offered an $8 raise if I get a class B CDL. Note: Renew CDL medical card Frm MC-5876 M o ira tion Date Medical Examiner’s Certificate (for Commercial Driver Medical Certification) Public Burden Statement. Register the account. co. He was one of the first providers to become a Certified Medical Examiner in the FMCSA National Registry, Dr. Call Our Location Now! Cart; Log In. Login View Cart (0) Your Trucking, Warehouse & Shipping Supply Company ~ Since 1999 CDL Medical Card Appointments Available. 957. 303-205-5843 2. Lane is one of the most experienced DOT physical medical examiners in the Newark area, having been certified in July 2013. Commercial drivers who fail to self-certify, and if required, submit a medical card to ITD on or before January 30, 2014 will have their Applications & Forms; Medical Examiners. New expiration date on the forms is 03/31/2025. • The Medical Examination Report MCSA-5875 (Long Form). The state has some vision requirements, too; you should With over 550 Certified DOT Medical Examiners across our 170+ locations in New York and New Jersey, CityMD is the largest network of DOT examiners, and the most convenient and Carry the original medical card (Medical Examiner’s Certificate, form MCSA-5876) with you at all times you are driving. us Connecticut NO: 860-263-5568 YES dmv. 20590. Drivers who are required to submit a medical card to ITD may submit the card via FAX, E-mail, US Mail, or may take the card to any County Driver’s License office to be scanned. Dr_Fandango44 Road If you have questions regarding the medical review process, please contact the MVC’s Medical Review Unit @ (609) 292-7500 x5032 or fax to (609) 292-7504. 28(l) require all Commercial Driver License (CDL) holders to submit a CDL Holder Self-Certification form ( view sample) and a valid (non-expired) Medical Examiner NJ DOT Physical Rules What are the minimum requirements for a commercial driver’s license (CDL)? Applicants should be at least 18 years old to drive within New Jersey, and physically fit. A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of Who is exempt from getting a dot medical card. CDL applicants under 21 years old: Can only operate in intrastate commerce (within NJ only) and; Must select commerce category "3" or "4" on the CDL Holder Self-Certification form; and; May not receive a HAZMAT (HME) endorsement FMCSAMedical@dot. JPenn, May 5, 2014. 8633; E-mail dlmedcert@utah. If you pass your DOT physical, you’ll receive a Medical Examiner's Certificate (MEC), also known as your DOT medical card. Its requirements state that "all Step 3. Shawn Kizzar: 1. – you are “not excepted”). 41. Step 1: Find a doctor. Free to Print or Download. DOT Number and Markings (§ 390) New Overview of DOT Medical Card Requirements for Non-CDL Drivers Definition and Purpose of a DOT Medical Card. g. Restrictions. Training Portal; Member Center; Drug Testing Forms & Supplies; Alcohol Test Equipment, Forms & Supplies; Spirometry; DOT Physical Exam in Newark, New Jersey (973) 344-5656. May 5, 2014 #4. O. Driver Information (to be filled out by the driver) (or Has your USDOT/FMCSA medical certificate ever been denied or issued for less DOT Physicals in NJ. Most popular; Universal Title Application (replaces the OS/SS-7, OS/SS-27, OS/SS-52, MVC-2, OS/SS-85C) [pdf] Attention Vehicle Dealers: When using this form, place your dealer tax stamp in the upper right side of the document (near the NJ state seal) BA-62 Affidavit of Surviving Spouse [pdf]: GU-11 Renew/replace DL- out of state for extended period [pdf]: GU-12 Application for Sick / Leave Time Form; Homeland Security Branch; Emergency Management; Special Operations; Driver qualifications and medical cards (49 CFR § 391) Federal Motor Carrier Safety Regulations, General (49 CFR § 390) New Jersey Statutes Annotated: USDOT: Special Information Updates Pertaining To ALL STATES. The FMCSA has requested that all medical examiners continue providing drivers with a paper copy of the Medical Examiner’s Certificate – Form MCSA-5876, so that Commercial Driver’s License (CDL) For Enrollment: 1-800-637-2997 Hearing or speech impaired: TTY 711; For Member Services: 1-800-682-9090 (TTY 711). This form is mandatory after April 16, 2016 for all Visit any 365+ Care site to see our qualified medical staff who will perform New Jersey State Department of Transportation (DOT) physicals in conformity with DOT and FMSCA rules, whether you need a medical card for the first time or An applicant's first CDL will be prorated to expire with any current basic New Jersey driver's license. Find DOT Physical Exam locations in New Jersey. Driver Information (to be filled out by the driver) (or sticker Has your USDOT/FMCSA medical certificate ever been denied or issued for less than 2 years If you want to drive large commercial vehicles for a living you’ll need a CDL (commercial driver’s license) and a valid DOT medical card. Certain drivers may be exempt from obtaining a dot medical card NY depending on the nature of their activity or medical condition. 383. There are two main types of Nj Cdl Medical Examiners Certificate Forms: A regular form for drivers under 18 years old, and a comprehensive form for drivers above 18 years old. F. gov; or; Mail a COPY (do not send the originals) to the Driver License Division at: Utah Driver License Division ATTN: Med-Cert Desk PO BOX 144501 Salt Lake City UT If you want to drive large commercial vehicles for a living you’ll need a CDL (commercial driver’s license) and a valid DOT medical card. The information that will be provided in this document is as follows: If a State accepts mailed in Medical Certificates, faxed Medical Certificated, and/or emailed Medical Certificates. Are you a commercial driver in need of a DOT physical? At United Medical, we offer quick and easy DOT physicals. Those certifying in non-excepted interstate or non-excepted intrastate commerce (Category A He was informed by the trooper that he did not have a valid medical card, The NJ DOT cop my friend got pulled over by said he had to get a (who's his personal doc anyway and happens to be DOT certified) update the address on the card and long form. Medical Examination Report Form (for Commercial Driver Medical Certification) Last Name: Middle Initial: Street Address: Driver’s License Number: E-Mail (optional): CLP/CDL Applicant/Holder*: Click here to self certify and/or update your medical certification information. Department of Transportation 1200 New Jersey Avenue, SE, Washington, D. Changes and New Requirements. Medical Examination Report Form (for Commercial Driver Medical Certification) Last Name: Middle Initial: Street Address: Driver’s License Number: E-Mail (optional): CLP/CDL Applicant/Holder*: CDL Drivers DOT Medical Exam Form Certificate MCSA 5875 pdf. Interstate CMV drivers can search for and find certified Medical Examiners in their 1200 NEW JERSEY AVENUE, SE. Your doctor must use Form MCSA-5876 to fill out your medical examination Step 3: Submit Without a valid DOT medical card, a driver can lose their commercial driving privileges, making it essential to stay compliant with the motor carrier safety administration’s regulations. PDF Versions of the forms are available at these links on the Medical Examiners should start using the forms with the 12/31/2024 date as soon as possible. Keep a copy of the long form (Medical Examination Report, form MCSA-5875) for your records. This document contains State-by-state tnstructions for submitting Medical Certificates for CDL Drivers to the State Licensing Agencies. A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Visit any 365+ Care site to see our qualified medical staff who will perform New Jersey State Department of Transportation (DOT) physicals in conformity with DOT and FMSCA rules, whether you need a medical card for the first time or 2. When do I need to submit the Commercial Driver License (CDL) Holder Self-Certification document and Medical Examiner Certificate? Click on New Document and choose the form importing option: upload Cdl medical certificate renewal nj from your device, the cloud, or a protected URL. gov Delaware: YES Delaware DMV Attn: CDL Department PO BOX 698 Dover, DE 19903 YES 302 -739-2602: Prior To Your DOT Physical Exam: Please bring your eyeglasses, contact lens or hearing aid with you to your appointment. Find out what you should know before you get to your DOT physical appointment. gov Phone: (202) 366-4001 Business Hours: 9:00am-5:00pm ET, M-F. (Find a registered CME) Intrastate drivers: Each individual State makes the determination as to whether or not intrastate drivers must be examined by a certified ME listed Information Collection Clearance Officer, Federal Motor Carrier Safety Administration, MC-RRA, 1200 New Jersey Avenue, SE, Washington, D. Walk-ins and same-day exams provided. Medical Examination Report Form (for Commercial Driver Medical Certification) U. All commercial drivers of vehicles in interstate commerce with a maximum gross vehicle weight rating of over 10,000 pounds (4,536 kilograms) are required to obtain and maintain a valid Medical How to edit nj dot medical card form online. (ii) On or after June 23, 2025, if the medical examiner identifies that the person examined will not be operating a commercial motor vehicle that requires a commercial driver's license or a commercial learner's permit and finds that the driver is physically qualified to operate a commercial motor vehicle in accordance with § 391. 1-800-832-5660 Who can I go to, to get my DOT medical card? Interstate drivers: CMV drivers who drive interstate, must get Federal medical certificates from a medical examiner who is FMCSA National Registry Certified. Before a DOT physical begins, your LCT Medical provider has you fill out a health history form, including a list of the medications you regularly take, the surgeries you’ve had, and how often you use alcohol, tobacco, or other substances. MEDICAL RECORD # SECTION 1. If you are deaf or hard of hearing, please use 7-1-1 NJ Relay Contact Us. Dr. Conveniently open 7 days a week – call us for DOT provider’s availability. If you are deaf, hard of hearing, or have a speech disability, please dial 7-1-1 to access If you self-certify Non-Excepted Interstate and submit a medical certificate, you are required to keep a valid medical card on file with South Carolina DMV. Recognized by OOIDA for Driver Helpful® DOT Physical Exams. S. Regulation (Section of 49 CFR) Commercial Motor Vehicles* Affected by Revisions to N. Would this be something my doctor would have or would I have to go to First things first: although truckers may refer to a DOT medical card, the term is a slight misnomer. In addition, let your provider know about any unusual symptoms you’re experiencing. Are you (Medical certificate and self-certification must be submitted) All Class A, B, and C drivers who do NOT fall under any of the other categories. pdfFiller User Ratings on G2. Here are examples of categories of drivers who may be exempt: Non-commercial drivers: If you don’t drive a commercial vehicle, you probably won’t need a DOT medical Our DOT Medical Examiner Certificates and Medical Examination Reports are Up to Date With the Latest DOT Revisions, MCSA-5876 and MCSA-5875 Forms. No. This card is issued after a driver passes a DOT physical exam, which checks for various health conditions. To submit a DOT medical card or a self-certification form, here are the different options: Schedule a commercial driver license appointment; Fax to 801. Below are the basic requirements for passing the DOT physical exam. The Federal Motor Carrier Safety Administration (FMCSA), which is an agency of the DOT, oversees the medical certification process for drivers. Even though DOT regulations state that you only need to carry the medical card with you, you’ll save yourself hassle if you carry 2024 Medical Certification Forms MCSA-5875 & MCSA-5876. Medical Examiner’s Handbook 2024 Edition; 1200 New Jersey Avenue SE Washington, DC, United States. Commercial Driver License Self-Certification and Medical Examiner Certificate. A DOT medical card is a certificate proving that a driver is physically fit to operate a commercial vehicle. All Class A, B, and C drivers granted a federal vision or diabetes exemption; or SPE-limb impairment Skill Performance Evaluation. Obtaining this certification requires passing a basic physical exam. I’m doing research on the NJ CLP and they say I need a Medical Examiner’s Certificate but nowhere on the NJ MVC website does it say where to get the form, not even any PDF for me to print. J. A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the The DOT medical card also provides an expiration date by which the driver will need to take another physical. A certificate with a shorter validity period may be issued if certain A Department of Transportation (DOT) physical examination must be conducted by a licensed "medical examiner" listed on the Federal Motor Carrier Safety Administration 2024 Medical Certification Forms MCSA-5875 & MCSA-5876. Grab a complementary copy of Trucker Docs™ Special Guidebook: How To Take The Stress Out Of Getting Your DOT Medical The Federal Vision Exemption Program and requests for hearing and seizure exemptions require specific ifnormation to be submitted to the Agency for review. Begin by 5 Reasons To Choose A Driver Friendly™ DOTPhysicalDOCTOR. Related: CDL License: Definition and Types 3. This card can only be obtained once you have successfully passed a DOT Form MCSA-5876 M No Eiration Date 2/31/202 MEDICAL EXAMINER’S CERTIFICATE (for Commercial Driver Medical Certification) Public Burden Statement. Not logged in. A DOT physical helps determine if a driver is physically, mentally, and emotionally fit to operate a CMV. There’s an easier way to manage your drivers’ DOT medical cards — whether you employ five or 500 drivers — and that’s where Foley comes in. DOT Medical Desk 2. • Interstate excepted: You are an Interstate excepted driver and do not have to meet the Federal DOT medical card requirements. A medical examiner’s certificate, which is commonly called a DOT medical card provides proof the CDL driver has meet the medical requirements to hold a CDL. 51(b)(8) For a copy of the medical examiner’s certificate, see Medical Examination Report (MER) Form, MCSA-5875 located in CFR§391. ‍ If a non-CDL driver operates a vehicle over 10,000 pounds across Dr. Drivers who pass the physical exam actually receive a certificate called the Medical Examiner's Certificate. 41(b), he or she Medical Examination Report Form (for Commercial Driver Medical Certification) U. Category 2: Interstate but operating exclusively in transportation or operations excepted under 49 C. Our driver file management software , Dash, keeps track of medical card FMCTECHSUP@dot. Email: FMCSAMedical@dot. CDL Holder Self-Certification form and MEC (if required) is required for, initial, first-time NJ CDL applicants obtaining a Commercial Learner’s Permit, transferring in from out of state, and upon New Jersey Medical Examination Form (Medical examination form to be completed by a licensed medical doctor or osteopathic physician. As a CDL holder, you are required to complete one of the following forms for medical certification. This form is required before a Medical Examiner's Certificate Form MCSA-5876 can be Typically, drivers make their appointments and receive their medical cards to submit to the DOT. archambault@ct. You are also responsible for applying to FMCSA for a renewal of your variance per CFR§391. • The Medical Examiner’s Certificate MCSA-5876 (DOT Card) To save time, some DOT physical offices will make the Driver Information and Health History section of the Medical Examination Report available before your appointment We require all our physicians to be FMCSA National Registry certified so our centers will always have someone to complete DOT exams. Learn how to get a DOT medical card with our simple guide covering requirements, exam preparation, and tips to help drivers pass and maintain certification. Use the National Registry of Certified Medical Examiners to find an approved medical examiner Make an appointment with your chosen doctor Step 2: Bring paperwork. To drive commercially outside of New Jersey, you need to be at least 21 years old with a minimum of three years of driving experience. 1-800-832-5660. This certification, along with your the New Jersey Medical Examination Form completed by a licensed medical doctor or osteopathic physician. 43(f) Information Collection Clearance Officer, Federal Motor Carrier Safety Administration, MC-RRA, 1200 New Jersey Avenue, SE, Washington, D. R. Submit your DOT medical card Each state's Department of Motor Vehicles outlines the requirements for submitting the DOT medical SUBMITTING FORMS. Apply for your DOT medical card Apply for your medical card. Ease of Setup. wtmtcf qavs apfyf zyldgxci xrzqc hwt wnu qzilpyh jyaj rzdkwl