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                        Driver Medical RequirementsIn This Section
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   Contact Us
      Federal Motor Carrier Safety Administration
      
                    
            Medical Program
      
                          
            1200 New Jersey Avenue SEWashington, DC, DC 20590United States
      
          
    **Email:**FMCSAMedical@dot.gov**Phone:** (202) 366-4001**Business Hours:**9:00am-5:00pm ET, M-F
    If you are deaf, hard of hearing, or have a speech disability, please dial 7-1-1 to access telecommunications relay services.
                
                Medical Applications and Forms
    

    
    
          **Medical Examinations**

The expiration date on the Medical Examination Report Form, MCSA-5875, Medical Examiner's Certificate, MCSA-5876, Insulin-Treated Diabetes Mellitus Assessment Form, MCSA-5870, and the Vision Evaluation Report, Form MCSA–5871 has been updated to 12/31/2024, and all forms are posted below.  Please note that the only change to the forms is the change in the OMB expiration date from 11/30/2021 to 12/31/2024.

Medical Examiners should start using the forms with the 12/31/2024 date as soon as possible.  However, MEs that have purchased these forms in bulk, or require time to reprogram electronic system forms, may continue to use the old forms until stocks have been depleted or forms have been reprogrammed but should transition to use of the new forms as quickly as possible.  Based on this guidance, SDLAs are encouraged to continue to accept these forms.


Insulin-Treated Diabetes Mellitus Assessment Form, MCSA-5870
	Vision Evaluation Report, Form MCSA–5871
	Non-Insulin-Treated Diabetes Mellitus Assessment Form, MCSA-5872 (optional)
	Medical Examination Report (MER) Form, MCSA-5875
	Medical Examiner's Certificate (MEC), Form MCSA-5876
	391.41 CMV Driver Medication Form, MCSA-5895 (optional)**Medical Exemptions**

**Diabetes Package**

This package has been removed due to the update of the Diabetes Standard. For more information please visit the New Diabetes Standard Overview Webinar.

**Vision Package**

This package has been removed due to the update of the Vision Standard. For more information please visit the New Vision Standard Overview Webinar.

**Hearing Package**

Federal Hearing Exemption Application **(NEW)**
	Federal Hearing Exemption Application **(RENEWAL)**
	Medical Release Form (Hearing) SAMPLE
	Medical Release Form**Seizure Package**

Federal Seizure Exemption Application **(NEW)**
	Federal Seizure Exemption Application**(RENEWAL)**
	Medical Release Form (Seizure) SAMPLE
	Medical Release Form
      
    
          Last updated: Tuesday, February 20, 2024 U.S. DEPARTMENT OF TRANSPORTATION

**Federal Motor Carrier Safety Administration**

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