Driver physical form

index-ready This form is requested when medical information is needed to evaluate a driver's medical condition in relationship to safe driving. Primarily used by Driver Safety, this five-page document assists hearing officers to evaluate the physical and/or mental condition\(s\) of the driver and to determine what action, if any, to take with. Commercial Driver Fitness Determination Commercial Driver’s License, Medical Section Decatur Boulevard, Ste. R, Indianapolis, IN Telephone: () Fax: () 2. Health History Driver completes this section, but medical examiner is encouraged to discuss with driver. *Social Security Number. You will need to take and pass the Vision, Knowledge and Road tests to get your driver's license. The Non-Commercial Learner's Permit Application (DL) (PDF) is valid for one year from the date of your physical examination; however, the physical examination date may not be more than six months prior to your 16th birthday.

The Federal Motor Carrier Safety Administration requires that interstate commercial motor vehicle drivers maintain a current Medical Examiner’s Certificate (MEC), Form MCSA to drive. As part of the physical, drivers are required to fill out the medical history portion of the Medical Examination Report (MER) Form, MCSA DRIVER'S LICENSE. NUMBER/I.D. NUMBER: ALL QUESTIONS MUST BE ANSWERED (Check [4] Applicable Block) YES NO THIS FORM IS VALID FOR 1 YEAR FROM THE DATE OF PHYSICAL EXAMINATION. The physical date may not be more than 6 months prior to your 16th birthday. AUTHORIZATIONS AND CERTIFICATIONS. 1. PHYSICAL EXAMINATION FORM FOR DRIVER APPLICANT SAMPLE I. The examining physician must answer the following questions. A. What serious illness has the applicant had in the past five years? B. What injuries has the applicant had? C. Does the applicant take any drugs regularly? If so, name and give reason. D. Is the applicant required to wear corrected lenses?.

The form must be completed no earlier than six months prior to your 16th birthday. All information must be completed. Step 3. If the driver license examiner. Our physicians can prepare a completed medical examination report form for your to have the DOT physical exam to maintain their driver certification. The medical examiner will review the Health History section with the driver and conduct the physical examination. The medical form, Form F () will be.