Completing Form MCSA-5875 and Certificate Form MCSA-5876

The following is a statement from the FMCSA:

FMCSA has been informed that some Medical Examiners (MEs) are not using the current approved versions of the required driver examination forms and others are not completing all the fields on the forms. As a result of the Medical Examiner’s Certification Integration final rule, use of the Medical Examination Report Form, MCSA-5875 and Medical Examiner’s Certificate, Form MCSA-5876 are required and results of examinations must be recorded on these specific forms. These forms have been approved by the Office of Management and Budget and are published in 49 CFR 391.43(f)(2) and (h)(2), and therefore, must be used “as is.” Both forms must be filled out completely to be considered valid. If a driver provides a Medical Examiner’s Certificate, Form MCSA-5876 to the State Driver’s Licensing Agency (SDLA) that has missing information (e.g., ME’s phone number, occupation, license information, etc.), it is considered not valid and may not be accepted by the SDLA. Please ensure that you are using the current approved versions of the forms and that you are filling out each form completely.

Medical Examiners can download current DOT FMCSA NRCME Medical Examiner applications and forms here: https://www.fmcsa.dot.gov/medical/driver-medical-requirements/medical-applications-and-forms

If you have questions, please contact National Registry Technical Support at (617) 494-3003 or FMCtechsup@dot.gov.

Enroll in the NRCME Training Institute today or purchase our $99 NRCME Exam Reference Materials. Call us at (941) 600-8411 for more program information and for any current single provider enrollment discounts.

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10-Year Recertification Notice

Certified Medical Examiners on the National Registry are required to be recertified no sooner than 9 years and no later than 10 years from the date of issuance of their medical examiner certification credential. Recertification requires that providers complete an accredited training program such as ours and pass the in-person national NRCME certification examination.

Call (941) 600-8411 for a single-provider discount.

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