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                Insulin-Treated Diabetes Mellitus Assessment Form, MCSA-5870
		

		
		
					
							
		
					
  Document
              Insulin-Treated Diabetes Mellitus Assessment Form MCSA-5870_508.pdf (290.83 KB)

		
					About the Insulin Treated Diabetes Mellitus (ITDM) Assessment Form, MCSA-5870

As a part of the medical certification process for insulin treated diabetes mellitus (ITDM) individuals, the Federal Motor Carrier Safety Administration requires that the Insulin Treated Diabetes Mellitus Assessment Form (ITDM), MCSA-5870, be completed by the ITDM individual’s Treating Clinician attesting that the individual has a stable insulin regimen and properly controlled diabetes. ITDM individuals are required to provide the ITDM Assessment Form, MCSA-5870, to the Certified Medical Examiner within 45 days of completion by the Treating Clinician.
		
		

    
		
    
					Last updated: Thursday, August 10, 2023 U.S. DEPARTMENT OF TRANSPORTATION

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