Medical Examination Report Form MCSA-5875
The medical history and examination form used during a DOT physical.
Open official FMCSA form →Resources
Prepare for your appointment and your responsibilities
Official forms and helpful information for drivers, employees and employer representatives.
DOT medical forms
Driver resources
Insulin-Treated Diabetes Mellitus Assessment Form MCSA-5870
For drivers treated with insulin who require assessment by their treating clinician.
Open official FMCSA form →What to bring to a DOT physical
- Government-issued photo identification
- Current medication list and prescribing clinicians
- Glasses, contacts or hearing aids normally used
- Relevant specialist records or clearance letters
- Required condition-specific forms
Call before your appointment if you are unsure which records are needed.
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