Here’s How to Complete Form MCSA-5875

You need to complete Form MCSA-5875 any time you’re required to undergo a DOT physical exam for commercial driving. This includes:

• Applying for a new Commercial Driver’s License (CDL)
• Renewing your current CDL if a new medical certificate is required
• Updating your medical certification status with your State Driver Licensing Agency (SDLA)
• Returning to duty after a medical disqualification or expired certificate
• Starting a job that requires interstate CMV operation, hazmat transport, or passenger carriage

How to fill out Form MCSA-5875, in 4 steps:

Please keep in mind that only the first two sections (Pages 1–2) are completed by you (the driver). The rest is filled in by the certified medical examiner.

Step 1: Complete Driver Information (Section 1)

Enter your:

• Full name
  
• Date of birth
  
• Driver’s license number and issuing state
  
• CDL class and endorsements
• Employer (optional)

Use accurate, legal information that matches your CDL or state license records

Step 2: Fill Out Your Medical History (Section 2)

This section asks about your:

• Medical conditions (such as diabetes, high blood pressure, heart disease, seizures, etc.)
  
• Mental health history
  
• Use of hearing or vision aids
  
• Surgeries or past or recent hospitalizations
  
• Prescription and over-the-counter (OTC) medications you are on

It’s essential to disclose all current medications with dosage and frequency, including any supplements or treatments prescribed by your doctor.

Step 3: Sign the Certification Statement

After filling out your medical history, sign and date the form to confirm the information you provided is complete and accurate, and that you understand the form is used to determine your medical fitness to drive a CMV. This must be done before the examiner begins their part of the exam.

Step 4: Bring the Form to Your DOT Physical

Take your completed Form MCSA-5875, a valid ID, and required medical documents to your physical.

During the appointment, the examiner will review your responses, conduct vision, hearing, blood pressure, and urinalysis tests, and perform a physical examination, in order to complete the rest of the MCSA-5875 and issue Form MCSA-5876.

The average cost for a DOT physical exam that includes Form MCSA-5875 is between $75 and $150.

This typically includes a physical exam, urinalysis, vision and hearing tests, as well as completion of both Form MCSA-5875 and MCSA-5876.

Insurance generally does not cover this unless your employer requires the physical. Additional lab work (such as blood sugar or EKGs) may increase the total cost.

You can get the official Form MCSA-5875 from the FMCSA Medical Certification website, directly from your medical examiner’s office, or through certain employers or training programs.

Keep in mind that only the English version of the form is accepted for certification. While a Spanish reference version is available, it cannot be used for official purposes.

Mistakes on the form can delay or disqualify your certification.

The most common issues include leaving health questions incomplete, not listing all medications or supplements, entering incorrect driver’s license information, forgetting to sign the form, and failing to bring required documents like prescriptions or eyeglasses. 

Don’t forget your glasses!

The form itself doesn’t expire, but it must be filled out completely each time you take a DOT physical. 

The Medical Examiner’s Certificate (Form MCSA-5876), which is issued based on this form, is typically valid for up to 24 months if you meet all medical requirements. 

However, if the examiner identifies a condition that needs closer monitoring, the certificate may be issued for a shorter period—such as 3, 6, or 12 months.

If you don’t pass the DOT physical exam, the medical examiner is required to explain why and provide guidance on what to do next.

Here’s what typically happens:

1. Explanation of Disqualification
   The examiner will tell you which specific medical condition or issue caused you to be disqualified. This could be something like high blood pressure, vision or hearing problems, uncontrolled diabetes, or use of disqualifying medications. 
2. No Certificate Issued
   You won’t receive a Medical Examiner’s Certificate (Form MCSA-5876), which means you can’t legally drive a commercial motor vehicle until you meet the medical standards. 

Next Steps
The examiner may explain what you can do to become medically qualified—such as following up with a specialist, starting treatment, adjusting medications, or providing additional documentation (like a clearance letter from your doctor).