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· Bring Driver’s license.
· Consume water PRIOR to exam to produce urine specimen.
· Completed medical questionnaire (Section 1.) PRIOR to your exam (FMCSA Form MCSA-5875 (dot.gov).
*Eyeglasses.
*Hearing aids with additional batteries.
Diabetes- A letter from your treating provider of your last A1C and a copy of your yearly diabetic eye exam.
*If taking insulin, you are REQUIRED to have a completed the federal insulin form, by your treating healthcare provider, (Form MCSA-5870 (dot.gov).
*If you have had chest pain, a heart attack, heart disease, coronary artery stents, or any other form heart surgery, a cardiology consult is REQUIRED PRIOR to your DOT exam.
You are REQUIRED to bring a copy of your most recent cardiac stress test results (MUST be within 2 years), echocardiogram results (*if applicable), and a clearance letter from your cardiologist.
*If you have a pacemaker it is REQUIRED to bring documentation of your most recent pacemaker check (within 12 months).
*If you had a brain infection, stroke, mini stroke (TIA), seizure, head trauma, intracranial hemorrhage, dizziness, or syncope (passing out episode) you are REQUIRED to have had a neurology consult and clearance letter PRIOR to your DOT exam.
*If you have adult depression, Attention Deficit/Hyperactivity Disorder (ADHD),or any psychiatric disorders you are REQUIRED to provide documentation from your primary care provider or mental health provider about your diagnosis, treatment plan, plus a list of your current medications, for clearance.
*If you have sleep apnea, you are REQUIRED to bring the past 90-day usage compliance report for your CPAP machine, or an oral appliance letter from your provider or documentation related to COPD, emphysema conditions PRIOR to your DOT exam.
*If taking blood thinners, such as Warfarin (Coumadin), you are REQUIRED provide documentation of monthly INR results. You MUST have a therapeutic INR within a month of certification.
This list is inclusive but not exclusive to all DOT certification requirements (Driver Physical Qualification | FMCSA (dot.gov).
Your DOT certification will not be granted on this day if all pertinent REQUIREMENTS are not met.
Email us at ben@conceirgedotexams.com if you have any further questions.
MCSA-5875 Medical Examination Report Form MCSA-5875.pdf (pdf)
DownloadInsulin-Treated-Diabetes-Mellitus-Form-1 (1) (pdf)
DownloadMA-Instrastate-Waiver-Application (pdf)
DownloadMass CDL-Self-Certification-Form (pdf)
DownloadNH CDL-Self-Certification-Form (pdf)
Download391.41 CMV DRIVER MEDICATION FORM (pdf)
DownloadSchool Bus and School Pupil Transport (7D) (pdf)
DownloadPrintable Driver Check List (pdf)
DownloadMedical Examiner's Certificate Form MCSA-5876 (pdf)
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