DOT / FMCSA Federal Verified 2026-05-12mandatory

MCSA-5875Medical Examination Report Form (DOT)

Issued by Federal Motor Carrier Safety Administration (FMCSA)

MCSA-5875 is the DOT Medical Examination Report (MER) form completed by a Certified Medical Examiner during a commercial driver physical. It documents driver health history, examination findings, and certification decision under 49 CFR 391.43.

Also known as: DOT MER · CDL physical form · FMCSA medical exam

Official agency source Agency forms index

Key facts

Clinicians fill out · Employees complete · Submitted to regulator

When it’s used
Required for initial CDL medical certification and at each periodic recertification (typically every 24 months, shorter if medically indicated).
Who fills it out
Driver completes Section 1 (health history). Certified Medical Examiner listed on the FMCSA National Registry completes the examination, findings, and determination sections.
Who signs
Certified Medical Examiner (MD, DO, advanced practice nurse, PA, doctor of chiropractic) listed on the FMCSA National Registry under 49 CFR Part 390 Subpart D.
Where it goes
Examiner retains a copy for 3 years; uploads the determination to the FMCSA National Registry. Driver receives the MCSA-5876 certificate.
Electronic submission
Supported — examiners submit results to the FMCSA National Registry online.

Sources & citations

Every form we publish traces to an authoritative government source. We cite the issuing agency, the underlying statute, and the operative regulation so you can verify scope and signing authority for your own records.

  • Issuing agency

    FMCSA Medical Forms

    Last verified 2026-05-12

    VerifiedOpen

  • Regulation

    49 CFR §391.43 — Medical examination

    Last verified 2026-05-12

    VerifiedOpen

Attribution. Form maintained by the Federal Motor Carrier Safety Administration (FMCSA). BlueHive does not modify the underlying government PDF; the file you download is the agency original.

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