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New Dot Forms And Procedures Starting April 20, 2016
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On April 20, 2016, all DOT exams will need to be recorded on the new DOT Medical Examination Report form MCSA-5875 and drivers will be issued the new Medical Examiner's Certificate MCSA-5876, commonly called the DOT medical card. These forms and their instructions are available at https://nationalregistry.fmcsa.dot.gov/ResourceCenter/

The form is longer and more complicated. There are more questions for the driver to answer. Therefore, each exam will take longer to complete.

Here at Partners In Safety, we will be using an electronic DOT exam form for all exams done in the office. This procedure will improve accuracy by eliminating empty boxes in health history, eliminating cross outs and write overs, and eliminating illegible handwriting. To speed up the procedure, we have the ability to send emails directly to drivers to pre-fill their part of the form, which can be done on a smartphone. In addition, employer representatives with proper authorization will be able to view and print completed 5875 and 5876 forms online.

What is new on the Medical Examination Report Form (5875) and Medical Examiner's Certificate (5876)?

  • federal privacy act statement that the driver must sign
  • questions about whether the driver ever was denied a medical card
  • specific questions about surgery and medication.
  • more questions about health history
  • driver may respond "Not Sure" to any question
  • blood pressure guidelines removed from form, but no change in guidance
  • medical examiner completes determination on either pg. 4 for drivers who meet standards or pg. 5 for drivers who meet standards only with applicable state variances (DOES NOT APPLY TO NEW YORK STATE)
  • new 'determination pending' result option
  • new 'incomplete' result option
  • medical certificate has separate lines for unrestricted federal certification and intrastate state certification with state variances (New York State does not have variances)

New Procedures and Guidelines:

  • If a driver gets a short term certificate (ex., 3 months for elevated blood pressure), a full exam must be performed when driver returns. There are no "follow up" exams.
  • When drivers have exams, but further information is needed before they can be cleared (ex., sleep apnea compliance report or stress test report required), the examiner may decide to use determination pending status. No Medical certificate 5876 is issued.
  • If determination status is selected, the driver has up to 45 days to obtain the medical information needed. Determination pending status does not extend the expiration date of the current Medical Certificate. If the driver's Medical Certificate expires during the determination pending period, the driver cannot drive.
  • If the driver brings the required information to the medical examiner within the 45 days, the examiner may clear the driver by amending the original Medical Examination Report. The new expiration date of the Medical Examiner's Certificate is calculated form the date amended, not the original exam date.
  • By 2018, medical examiners will report exam results to Federal Motor Carrier Safety Administration (FMCSA) within 1 day of the exam, and FMCSA will forward the results to each State's Department of Motor Vehicles. Currently, examiners have until the last day of the month following the exam to report to FMCSA and FMCSA does not report the results to the states.

Tips for exams and reviewing these forms:

  • allow more time for each physical
  • encourage drivers to bring all medical notes (cardiac, diabetic, sleep apnea, medication) to the physical exam to avoid being put in 'determination pending' status
  • privacy act must be signed by the driver
  • as always, all health history questions must be answered
  • in New York and states without variances, medical examiner completes determination on page 4 only
  • page 5 should never be completed in New York, page 5 should be blank or deleted
  • determination pending status does not extend medical certification period
  • on Medical Examiner's Certificate 5876, the top qualification line must be selected:
    "the Federal Motor Carrier Safety Regulations (49 CFR 391.41-391.49) and, with knowledge of the driving duties, I find this person is qualified, and, if applicable, only when (check all that apply)
  • in New York and other states that don't have variances, the second line should never be checked:
    "the Federal Motor Carrier Safety Regulations (49 CFR 391.41-391.49) with any applicable State variances (which will only be valid for intrastate operations), and, with knowledge of the driving duties, I find this person is qualified, and, if applicable, only when (check all that apply):"

Please contact Partners In Safety's Corporate Office at 866-411-SAFE (7233) if you have any questions or comments.