Regulatory Alert: Effective April 1, 2025 The FMCSA has reissued its Medical Examiner’s Certificate and Medical Examination Report Form with a new OMB expiration date of “3/31/2028” in the upper right corner and a revision (rev) date of “3/27/25” in the lower right corner. The FMCSA is allowing medical examiners to use up their existing stock of older forms. FMCSA is encouraging, but not requiring, state licensing agencies to continue accepting them. However, motor carriers and medical examiners are advised to switch to the new forms as soon as possible.

• Expiration Date: 3/31/2028.
• Helps you comply with 49 CFR §391.43
• Form MCSA-5875
• Both the Medical Examination Report and Medical Examination Certificate are required by the DOT
• Contains applicable regulations, instructions to the medical examiner and the form itself
• This DOT medical examination report is 9 pages long
• Measures 8-1/2" x 11”