Save 45% - Medical Examination Report, 9-Part, 8.5" x 11"

Item No. DQF65R3
Pack 25
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price per Pack 25
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Item Description

Help stay in compliance with Labelmaster's Medical Examination Report. An integral part of the driver qualification file, this form for commercial driver fitness determination contains information required by 49 CFR 391.41. There are 5 pages of information to fill in and 4 pages of instructions, for a total of 9 pages. It measures 8.5 x 11 in. and is sold in packs of 25.

Note: On July 7, 2021, FMCSA revised the Medical Examination Report form MCSA-5875 to remove the question about the driver’s gender with an effective date of September 7, 2021. Labelmaster’s current inventory of forms still includes the driver gender question; however, FMCSA have confirmed that it is acceptable to deplete existing inventory of these forms and have the Medical Examiner simply cross out the gender line on the form, or write “N/A”. Since the forms are scheduled to be updated by FMCSA in November 2021 with a new OMB expiration date, Labelmaster will print new forms and replace existing inventory at that time.

Width 8.5 "
Height 11 "
Format Pack
Format Unit Of Measure 25
UPC Code 887277150368
Manufacturer Number DQF65R3
Manufacturer Name Ameriprint Corporation
Regulatory Agency DOT
Regulatory Standard Part 391.43 (h)
Material Polypropylene/Cellulose
Weight 1.5 lbs
Country Of Origin US
Harmonized Tariff Code 4820400000
UNSPSC Code 14111800